Provider Demographics
NPI:1467948125
Name:MCDANIEL, COURTNEY MICHELLE
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:MICHELLE
Last Name:MCDANIEL
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 1:2203 HARMONY ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3028
Mailing Address - Country:US
Mailing Address - Phone:318-805-7772
Mailing Address - Fax:
Practice Address - Street 1:2203 HARMONY ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3028
Practice Address - Country:US
Practice Address - Phone:318-805-7772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-06
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator