Provider Demographics
NPI:1437699279
Name:BAHAM, KOURTNIE (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:KOURTNIE
Middle Name:
Last Name:BAHAM
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:KOURTNIE
Other - Middle Name:KEISHELL
Other - Last Name:SALVANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:117 SUMMER CYPRESS LANE
Mailing Address - Street 2:
Mailing Address - City:BELLE CHASSE
Mailing Address - State:LA
Mailing Address - Zip Code:70037
Mailing Address - Country:US
Mailing Address - Phone:504-912-6393
Mailing Address - Fax:
Practice Address - Street 1:117 SUMMER CYPRESS LN
Practice Address - Street 2:
Practice Address - City:BELLE CHASSE
Practice Address - State:LA
Practice Address - Zip Code:70037
Practice Address - Country:US
Practice Address - Phone:504-912-6393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-27
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7906101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty