Provider Demographics
NPI:1225801228
Name:HAM, COURTNEY (LADC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:HAM
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 DIVISION ST S
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:MN
Mailing Address - Zip Code:55052-5122
Mailing Address - Country:US
Mailing Address - Phone:320-262-0515
Mailing Address - Fax:
Practice Address - Street 1:529 WOODLEY ST W
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55057-2765
Practice Address - Country:US
Practice Address - Phone:507-225-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306708101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)