Provider Demographics
NPI:1861689275
Name:COURTLAND PSYCHOLOGICAL SERVICES, P.A.
Entity Type:Organization
Organization Name:COURTLAND PSYCHOLOGICAL SERVICES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COLETTE
Authorized Official - Middle Name:C
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-838-5270
Mailing Address - Street 1:25 W COURTLAND ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3749
Mailing Address - Country:US
Mailing Address - Phone:410-838-5270
Mailing Address - Fax:
Practice Address - Street 1:25 W COURTLAND ST
Practice Address - Street 2:SUITE 202
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3749
Practice Address - Country:US
Practice Address - Phone:410-838-5270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-29
Last Update Date:2007-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2823103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD288AOtherBLUE CROSS BLUE SHIELD