Provider Demographics
NPI:1639933294
Name:BASCH, COURTNEY ELLE
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ELLE
Last Name:BASCH
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 1:13015 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4836
Mailing Address - Country:US
Mailing Address - Phone:818-983-7505
Mailing Address - Fax:
Practice Address - Street 1:12424 WILSHIRE BLVD STE 65012424
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1052
Practice Address - Country:US
Practice Address - Phone:310-571-8760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA144819106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist