Provider Demographics
NPI:1538687975
Name:COURTS, JOHANNA
Entity Type:Individual
Prefix:MS
First Name:JOHANNA
Middle Name:
Last Name:COURTS
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 1:2731 NW 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33311-2019
Mailing Address - Country:US
Mailing Address - Phone:561-805-0378
Mailing Address - Fax:
Practice Address - Street 1:3090 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-7612
Practice Address - Country:US
Practice Address - Phone:561-805-0378
Practice Address - Fax:954-827-0285
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-06
Last Update Date:2020-10-20
Deactivation Date:2018-02-12
Deactivation Code:
Reactivation Date:2019-10-10
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL651006432Medicaid