Provider Demographics
NPI:1619304672
Name:ZAMUDIO, COURTNEY LEE
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LEE
Last Name:ZAMUDIO
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 1:309 E TWELVE OAKS TER
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-4913
Mailing Address - Country:US
Mailing Address - Phone:231-633-0375
Mailing Address - Fax:
Practice Address - Street 1:309 E TWELVE OAKS TER
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-4913
Practice Address - Country:US
Practice Address - Phone:231-633-0375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional