Provider Demographics
NPI:1134901887
Name:LEBOEUF, COURTNEY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:LEBOEUF
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W LLANO DR
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-4302
Mailing Address - Country:US
Mailing Address - Phone:623-455-1042
Mailing Address - Fax:
Practice Address - Street 1:1655 N TEGNER ST
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-1461
Practice Address - Country:US
Practice Address - Phone:877-800-5810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ298920363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health