Provider Demographics
NPI:1144606138
Name:COURTNEY DU MOND, PH.D. LICENSED CLINICAL PSYCHOLOGIST
Entity Type:Organization
Organization Name:COURTNEY DU MOND, PH.D. LICENSED CLINICAL PSYCHOLOGIST
Other - Org Name:LAKESIDE BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:DU MOND
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:315-558-7631
Mailing Address - Street 1:2 SOUTH ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-3833
Mailing Address - Country:US
Mailing Address - Phone:315-558-7631
Mailing Address - Fax:315-253-3403
Practice Address - Street 1:2 SOUTH ST
Practice Address - Street 2:STE 204
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3833
Practice Address - Country:US
Practice Address - Phone:315-558-7631
Practice Address - Fax:315-370-9964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2017-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019038-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty