Provider Demographics
NPI:1114621737
Name:RUSSELL, COURTNEY ELIZABETH (PSYD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:ELIZABETH
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:PSYD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 EDWARDS VILLAGE BLVD # D208
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:CO
Mailing Address - Zip Code:81632-5277
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:210 EDWARDS VILLAGE BLVD # D208
Practice Address - Street 2:
Practice Address - City:EDWARDS
Practice Address - State:CO
Practice Address - Zip Code:81632-5277
Practice Address - Country:US
Practice Address - Phone:970-446-6481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-21-51634103K00000X
COPSYC.00015020103TC0700X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical