Provider Demographics
NPI:1609471598
Name:NIGHTANGEL, CORTNEY (LPC)
Entity Type:Individual
Prefix:
First Name:CORTNEY
Middle Name:
Last Name:NIGHTANGEL
Suffix:
Gender:F
Credentials:LPC
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 69
Mailing Address - Street 2:
Mailing Address - City:BLUNT
Mailing Address - State:SD
Mailing Address - Zip Code:57522-0069
Mailing Address - Country:US
Mailing Address - Phone:860-338-6151
Mailing Address - Fax:
Practice Address - Street 1:302 N LONETREE AVE
Practice Address - Street 2:
Practice Address - City:BLUNT
Practice Address - State:SD
Practice Address - Zip Code:57522-2029
Practice Address - Country:US
Practice Address - Phone:860-338-6151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5293101YP2500X
SD20781101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional