Provider Demographics
NPI:1922581800
Name:HEATH, COURTNEY CORINNE
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:CORINNE
Last Name:HEATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:CORINNE
Other - Last Name:HURLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, EDS
Mailing Address - Street 1:9477 STATE ROUTE 235 N
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:OH
Mailing Address - Zip Code:43343-9507
Mailing Address - Country:US
Mailing Address - Phone:937-441-8685
Mailing Address - Fax:
Practice Address - Street 1:607 N PIKE ST
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:OH
Practice Address - Zip Code:45302-9806
Practice Address - Country:US
Practice Address - Phone:937-394-2584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21579661103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool