Provider Demographics
NPI:1750628855
Name:COURTNEY, ANGELLA CHRISTINE (MS)
Entity Type:Individual
Prefix:MS
First Name:ANGELLA
Middle Name:CHRISTINE
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:ANGELLA
Other - Middle Name:CHRISTINE
Other - Last Name:MCKINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:16418 129TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-9601
Mailing Address - Country:US
Mailing Address - Phone:253-905-8228
Mailing Address - Fax:
Practice Address - Street 1:426 N MERIDIAN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-8636
Practice Address - Country:US
Practice Address - Phone:253-350-3317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-09
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health