Provider Demographics
NPI:1407520711
Name:DEBRUYCKER, KOURTNEY
Entity Type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:
Last Name:DEBRUYCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 STARR RD
Mailing Address - Street 2:
Mailing Address - City:FLOWEREE
Mailing Address - State:MT
Mailing Address - Zip Code:59440-9024
Mailing Address - Country:US
Mailing Address - Phone:406-498-6903
Mailing Address - Fax:
Practice Address - Street 1:1500 10TH AVE S STE 200
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-2619
Practice Address - Country:US
Practice Address - Phone:406-498-6903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT50141101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health