Provider Demographics
NPI:1770236531
Name:DERICHSWEILER, COURTNEY LEE
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LEE
Last Name:DERICHSWEILER
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 1:2725 ROSANNA ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-3047
Mailing Address - Country:US
Mailing Address - Phone:209-559-8999
Mailing Address - Fax:
Practice Address - Street 1:5765 S RAINBOW BLVD STE 111
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-2537
Practice Address - Country:US
Practice Address - Phone:209-559-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst