Provider Demographics
NPI:1619552825
Name:LEERSSEN, COURTNEY SAVANNAH (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:SAVANNAH
Last Name:LEERSSEN
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5808 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-1222
Mailing Address - Country:US
Mailing Address - Phone:972-342-2841
Mailing Address - Fax:
Practice Address - Street 1:1163 W JOHN CARPENTER FWY
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-7503
Practice Address - Country:US
Practice Address - Phone:972-217-4090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-20-45474103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-20-45474OtherBACB CERTIFICATION NUMBER