Provider Demographics
NPI:1043965692
Name:PRUDHOMME, COURTNEY DANIELLE (MED, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:DANIELLE
Last Name:PRUDHOMME
Suffix:
Gender:F
Credentials:MED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 BENS BRANCH DR APT 2604
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-4916
Mailing Address - Country:US
Mailing Address - Phone:409-659-8416
Mailing Address - Fax:
Practice Address - Street 1:2611 BENS BRANCH DR APT 2604
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-4916
Practice Address - Country:US
Practice Address - Phone:409-659-8416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-12
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79912101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional