Provider Demographics
NPI:1093221061
Name:MAZEY, COURTNEY TODD (MAC, PC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:TODD
Last Name:MAZEY
Suffix:
Gender:M
Credentials:MAC, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4334 VICTORIA TER SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-4841
Mailing Address - Country:US
Mailing Address - Phone:330-507-8818
Mailing Address - Fax:
Practice Address - Street 1:8261 MARKET ST
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6254
Practice Address - Country:US
Practice Address - Phone:330-286-0050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0900529101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional