Provider Demographics
NPI:1831677137
Name:PRUDHOMME, COURTNEY (LPC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:PRUDHOMME
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 SPRINGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-9513
Mailing Address - Country:US
Mailing Address - Phone:281-254-3758
Mailing Address - Fax:
Practice Address - Street 1:535 SPRINGWOOD DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-9513
Practice Address - Country:US
Practice Address - Phone:281-254-3758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76382251B00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No251B00000XAgenciesCase Management