Provider Demographics
NPI:1598380040
Name:CAULDWELL, COURTNEY JENE
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:JENE
Last Name:CAULDWELL
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 1:6801 W 121ST ST STE 107
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-2005
Mailing Address - Country:US
Mailing Address - Phone:913-228-2915
Mailing Address - Fax:
Practice Address - Street 1:6801 W 121ST ST STE 107
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-2005
Practice Address - Country:US
Practice Address - Phone:913-228-2915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3608101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health