Provider Demographics
NPI:1669887907
Name:JOHN COURTNEY LLC
Entity type:Organization
Organization Name:JOHN COURTNEY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:COURTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, MP
Authorized Official - Phone:504-208-9476
Mailing Address - Street 1:118 TERRA BELLA BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8148
Mailing Address - Country:US
Mailing Address - Phone:504-208-9476
Mailing Address - Fax:
Practice Address - Street 1:118 TERRA BELLA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8148
Practice Address - Country:US
Practice Address - Phone:504-208-9476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMPAP103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1004812Medicaid