Provider Demographics
NPI:1427576099
Name:DEMILLE, COURTNEY (LPT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:DEMILLE
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7824 BELLINGRATH DR
Mailing Address - Street 2:
Mailing Address - City:ELVERTA
Mailing Address - State:CA
Mailing Address - Zip Code:95626-9725
Mailing Address - Country:US
Mailing Address - Phone:530-788-3878
Mailing Address - Fax:
Practice Address - Street 1:137 N COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-6646
Practice Address - Country:US
Practice Address - Phone:530-666-8630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40521167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician