Provider Demographics
NPI:1275713331
Name:STIVERS, COURTNEY LEIGH (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:LEIGH
Last Name:STIVERS
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:LEIGH
Other - Last Name:HIRST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1717 W CANDLETREE DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-1592
Mailing Address - Country:US
Mailing Address - Phone:501-593-3069
Mailing Address - Fax:
Practice Address - Street 1:1717 W CANDLETREE DR
Practice Address - Street 2:SUITE B
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1592
Practice Address - Country:US
Practice Address - Phone:501-593-3069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA0710079101YP2500X
ARP1010069101YP2500X
ARA1101007106H00000X
IL166001031106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional