Provider Demographics
NPI:1124226493
Name:DAVENPORT, COURTNEY K
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:K
Last Name:DAVENPORT
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 1:18302 IRVINE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3435
Mailing Address - Country:US
Mailing Address - Phone:714-881-8606
Mailing Address - Fax:
Practice Address - Street 1:18302 IRVINE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3435
Practice Address - Country:US
Practice Address - Phone:714-881-8606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health