Provider Demographics
NPI:1912188707
Name:CASEY, COURTNEY BRYANNA LYNNE (MA, QMHP)
Entity Type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:BRYANNA LYNNE
Last Name:CASEY
Suffix:
Gender:F
Credentials:MA, QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 NW COUNCIL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3725
Mailing Address - Country:US
Mailing Address - Phone:503-258-4600
Mailing Address - Fax:503-667-2580
Practice Address - Street 1:831 NW COUNCIL DR STE 300
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3725
Practice Address - Country:US
Practice Address - Phone:503-258-4600
Practice Address - Fax:503-667-2580
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health