Provider Demographics
NPI:1568222834
Name:MAYER, COURTNEY LEE (MED/EDS)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LEE
Last Name:MAYER
Suffix:
Gender:F
Credentials:MED/EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10730 N PRESERVE WAY APT 207
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-6569
Mailing Address - Country:US
Mailing Address - Phone:561-635-9620
Mailing Address - Fax:
Practice Address - Street 1:10730 N PRESERVE WAY APT 207
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-6569
Practice Address - Country:US
Practice Address - Phone:561-635-9620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH23341101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health