Provider Demographics
NPI:1336690924
Name:FARMER, COURTNEY CHAPPUIS (PHD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:CHAPPUIS
Last Name:FARMER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 LODATO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1723
Mailing Address - Country:US
Mailing Address - Phone:337-288-4952
Mailing Address - Fax:
Practice Address - Street 1:87 LODATO AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1723
Practice Address - Country:US
Practice Address - Phone:337-288-4952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28514103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical