Provider Demographics
NPI:1760769269
Name:COURNOYER, JOHN A (MA)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:A
Last Name:COURNOYER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9050 58TH DR E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-6104
Mailing Address - Country:US
Mailing Address - Phone:941-907-0525
Mailing Address - Fax:
Practice Address - Street 1:5460 LENA RD
Practice Address - Street 2:SUITE 103
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-9500
Practice Address - Country:US
Practice Address - Phone:941-907-0525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH9214101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health