Provider Demographics
NPI:1235829151
Name:FRACK, COURTNEY (MS, LMLP, LMAC)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:
Last Name:FRACK
Suffix:
Gender:F
Credentials:MS, LMLP, LMAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20512 US HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:KS
Mailing Address - Zip Code:67654-5481
Mailing Address - Country:US
Mailing Address - Phone:785-543-9011
Mailing Address - Fax:
Practice Address - Street 1:205 F ST
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:KS
Practice Address - Zip Code:67661-1943
Practice Address - Country:US
Practice Address - Phone:785-543-9011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMAC01093103TA0400X
KSLMLP2692103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)