Provider Demographics
NPI:1437429925
Name:CARROLL SPILKER, COURTNEY M (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:M
Last Name:CARROLL SPILKER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:M
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:927 45TH ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2450
Mailing Address - Country:US
Mailing Address - Phone:561-623-4980
Mailing Address - Fax:561-623-4981
Practice Address - Street 1:927 45TH ST
Practice Address - Street 2:SUITE 301
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2450
Practice Address - Country:US
Practice Address - Phone:561-623-4980
Practice Address - Fax:561-623-4981
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-30
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLPY9096103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program