Provider Demographics
NPI:1083792469
Name:SEYLER, COURTNEY SUE
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:SUE
Last Name:SEYLER
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 1:1225 S MAIN ST
Mailing Address - Street 2:SUITE 201B
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-5370
Mailing Address - Country:US
Mailing Address - Phone:724-832-1700
Mailing Address - Fax:
Practice Address - Street 1:1225 S MAIN ST
Practice Address - Street 2:SUITE 201B
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-5370
Practice Address - Country:US
Practice Address - Phone:724-832-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000424106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA550760Medicaid