Provider Demographics
NPI:1013575778
Name:DUFOUR, COURTNEY DANIELLE
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:DANIELLE
Last Name:DUFOUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2063 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32796-3243
Mailing Address - Country:US
Mailing Address - Phone:321-888-3020
Mailing Address - Fax:661-263-4584
Practice Address - Street 1:2063 GARDEN ST
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32796-3243
Practice Address - Country:US
Practice Address - Phone:321-888-3020
Practice Address - Fax:661-263-4584
Is Sole Proprietor?:No
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician