Provider Demographics
NPI:1043617772
Name:NEAL, COURTNEY D
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:D
Last Name:NEAL
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 1:555 N WOODLAWN ST STE 3105
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3673
Mailing Address - Country:US
Mailing Address - Phone:316-685-1821
Mailing Address - Fax:316-685-0768
Practice Address - Street 1:555 N WOODLAWN ST STE 3105
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3673
Practice Address - Country:US
Practice Address - Phone:316-685-1821
Practice Address - Fax:316-685-0768
Is Sole Proprietor?:No
Enumeration Date:2014-11-24
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker