Provider Demographics
NPI:1548603954
Name:KLEINEBREIL, COURTNEY BETH (MC, LISAC, LAC, BHP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:BETH
Last Name:KLEINEBREIL
Suffix:
Gender:F
Credentials:MC, LISAC, LAC, BHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:868 E UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-8033
Mailing Address - Country:US
Mailing Address - Phone:480-969-6955
Mailing Address - Fax:480-733-3044
Practice Address - Street 1:868 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-8033
Practice Address - Country:US
Practice Address - Phone:480-969-6955
Practice Address - Fax:480-733-3044
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC11401101YA0400X
AZLAC11711101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)