Provider Demographics
NPI:1497170179
Name:RITCHIE, COURTNEY (RN)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:RITCHIE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24435 PLYMOUTH RD
Mailing Address - Street 2:9315 TELEGRAPH
Mailing Address - City:REDFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48239-1616
Mailing Address - Country:US
Mailing Address - Phone:313-450-4500
Mailing Address - Fax:313-450-0404
Practice Address - Street 1:24435 PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:REDFORD
Practice Address - State:MI
Practice Address - Zip Code:48239
Practice Address - Country:US
Practice Address - Phone:313-450-0400
Practice Address - Fax:313-450-0404
Is Sole Proprietor?:No
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704199963103K00000X, 2084B0040X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice