Provider Demographics
NPI:1134483415
Name:PICKETT, CORTNIE ERIN (MA, LPC, EMDR, SOMB)
Entity Type:Individual
Prefix:
First Name:CORTNIE
Middle Name:ERIN
Last Name:PICKETT
Suffix:
Gender:F
Credentials:MA, LPC, EMDR, SOMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 N WEBER ST STE 235
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1019
Mailing Address - Country:US
Mailing Address - Phone:719-359-1143
Mailing Address - Fax:719-633-3023
Practice Address - Street 1:731 N WEBER ST STE 235
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1019
Practice Address - Country:US
Practice Address - Phone:719-359-1143
Practice Address - Fax:719-633-3023
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-01
Last Update Date:2012-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6202101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional