Provider Demographics
NPI:1669034971
Name:RICHEY, COURTNEY KOTENKO (LLPC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:KOTENKO
Last Name:RICHEY
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8167 BELLARINE DR
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48316-3607
Mailing Address - Country:US
Mailing Address - Phone:586-484-8246
Mailing Address - Fax:
Practice Address - Street 1:35455 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48035-2236
Practice Address - Country:US
Practice Address - Phone:586-792-5335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017618101Y00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor