Provider Demographics
NPI:1629839253
Name:WITTKOPF, COURTNIE (LCDC, LPC-A)
Entity Type:Individual
Prefix:
First Name:COURTNIE
Middle Name:
Last Name:WITTKOPF
Suffix:
Gender:F
Credentials:LCDC, LPC-A
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 545
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-0010
Mailing Address - Country:US
Mailing Address - Phone:469-861-6101
Mailing Address - Fax:
Practice Address - Street 1:307 S JUPITER RD STE 110
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-3051
Practice Address - Country:US
Practice Address - Phone:469-861-6101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YP2500X
TX15685101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional