Provider Demographics
NPI:1003606807
Name:SHALL, COURTNEY LEE (MA, NBCC, LPC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LEE
Last Name:SHALL
Suffix:
Gender:
Credentials:MA, NBCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 DRISKEL RD
Mailing Address - Street 2:
Mailing Address - City:LORETTO
Mailing Address - State:PA
Mailing Address - Zip Code:15940-8211
Mailing Address - Country:US
Mailing Address - Phone:814-312-2664
Mailing Address - Fax:
Practice Address - Street 1:351 DRISKEL RD
Practice Address - Street 2:
Practice Address - City:LORETTO
Practice Address - State:PA
Practice Address - Zip Code:15940-8211
Practice Address - Country:US
Practice Address - Phone:814-312-2664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional