Provider Demographics
NPI:1356861322
Name:REIS, COURTNEE ELLEN (LPCC 7732)
Entity type:Individual
Prefix:
First Name:COURTNEE
Middle Name:ELLEN
Last Name:REIS
Suffix:
Gender:F
Credentials:LPCC 7732
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 FAIRMONT DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-4522
Mailing Address - Country:US
Mailing Address - Phone:951-532-0898
Mailing Address - Fax:
Practice Address - Street 1:1731 FAIRMONT DR
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-4522
Practice Address - Country:US
Practice Address - Phone:951-532-0898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4239101YP2500X
CA7732101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional