Provider Demographics
NPI:1801281944
Name:SEABORG, COURTNEY (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:SEABORG
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:M
Other - Last Name:COULTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:1833 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ANOKA
Mailing Address - State:MN
Mailing Address - Zip Code:55303-2424
Mailing Address - Country:US
Mailing Address - Phone:763-421-5535
Mailing Address - Fax:763-433-0226
Practice Address - Street 1:3305 CENTRAL PARK VILLAGE DR STE 200
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55121-7707
Practice Address - Country:US
Practice Address - Phone:651-406-8860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN244141041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical