Provider Demographics
NPI:1235894361
Name:COURTNEY, NICOLE GOREN (LMFT120155)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:GOREN
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:LMFT120155
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:PAULINE
Other - Last Name:GOREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17631 VENTURA BLVD # 330
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3842
Mailing Address - Country:US
Mailing Address - Phone:818-331-9642
Mailing Address - Fax:
Practice Address - Street 1:3921 W SUNSET BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029
Practice Address - Country:US
Practice Address - Phone:646-661-1690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120155106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist