Provider Demographics
NPI:1396469615
Name:HIRSCH, COURTNEY L
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:L
Last Name:HIRSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:L
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24257 S TIMBERLINE TRL
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-2728
Mailing Address - Country:US
Mailing Address - Phone:219-313-0568
Mailing Address - Fax:
Practice Address - Street 1:1101 CUMBERLAND XING # 108
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2356
Practice Address - Country:US
Practice Address - Phone:866-413-1988
Practice Address - Fax:866-628-8599
Is Sole Proprietor?:No
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician