Provider Demographics
NPI:1407619471
Name:MULLENAX, COURTNEY LEANN
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LEANN
Last Name:MULLENAX
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 1:1123 HORSESHOE RD
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-6821
Mailing Address - Country:US
Mailing Address - Phone:304-813-9301
Mailing Address - Fax:
Practice Address - Street 1:1123 HORSESHOE RD
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-6821
Practice Address - Country:US
Practice Address - Phone:304-813-9301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator