Provider Demographics
NPI:1114433281
Name:COLLIER, COURTNEY DWAYNE (MBA, CPRS)
Entity Type:Individual
Prefix:MR
First Name:COURTNEY
Middle Name:DWAYNE
Last Name:COLLIER
Suffix:
Gender:M
Credentials:MBA, CPRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MARTIN LUTHER KING JR. DR.
Mailing Address - Street 2:#7730
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38302
Mailing Address - Country:US
Mailing Address - Phone:731-300-1104
Mailing Address - Fax:
Practice Address - Street 1:30 SANDSTONE CIR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2073
Practice Address - Country:US
Practice Address - Phone:731-240-1695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-27
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN-068101YA0400X
TN000-1142175T00000X
TN1600101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty