Provider Demographics
NPI:1508563404
Name:RUTTER, COURTENEY CHRISTINE
Entity Type:Individual
Prefix:
First Name:COURTENEY
Middle Name:CHRISTINE
Last Name:RUTTER
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:PO BOX 10132
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-0132
Mailing Address - Country:US
Mailing Address - Phone:908-380-0994
Mailing Address - Fax:
Practice Address - Street 1:1490 GREGORY LN
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-9021
Practice Address - Country:US
Practice Address - Phone:307-734-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-10
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPPC-1349101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health