Provider Demographics
NPI:1043989072
Name:MENTEN, COURTNEY JO (MS, LPCC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:JO
Last Name:MENTEN
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 973
Mailing Address - Street 2:
Mailing Address - City:MOOSE LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55767-0973
Mailing Address - Country:US
Mailing Address - Phone:507-251-6070
Mailing Address - Fax:
Practice Address - Street 1:603 VINE ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-4058
Practice Address - Country:US
Practice Address - Phone:763-363-3036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00765101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional