Provider Demographics
NPI:1316409493
Name:SYKES, COURTNEY (L9695)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:SYKES
Suffix:
Gender:F
Credentials:L9695
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 LAKEWOOD CENTER MALL # 36
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-2417
Mailing Address - Country:US
Mailing Address - Phone:626-714-9608
Mailing Address - Fax:562-337-3119
Practice Address - Street 1:61 LAKEWOOD CENTER MALL # 36
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-2417
Practice Address - Country:US
Practice Address - Phone:626-714-9608
Practice Address - Fax:562-337-3119
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-05
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 175T00000X
CAL9695174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No175T00000XOther Service ProvidersPeer Specialist