Provider Demographics
NPI:1295005965
Name:THUNBERG, COURTNIE LEE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:COURTNIE
Middle Name:LEE
Last Name:THUNBERG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21395 JOHN MILLESS DR. #400
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374
Mailing Address - Country:US
Mailing Address - Phone:763-424-1888
Mailing Address - Fax:763-424-7288
Practice Address - Street 1:21395 JOHN MILLESS DR. #400
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374
Practice Address - Country:US
Practice Address - Phone:763-424-1888
Practice Address - Fax:763-424-7288
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2230106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2230OtherLICENSE