Provider Demographics
NPI:1811251648
Name:COURTER, MARCIE LEE (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARCIE
Middle Name:LEE
Last Name:COURTER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 ALEA PL
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8723
Mailing Address - Country:US
Mailing Address - Phone:808-866-4245
Mailing Address - Fax:
Practice Address - Street 1:1325 S KIHEI RD STE 226A
Practice Address - Street 2:
Practice Address - City:KIHEI
Practice Address - State:HI
Practice Address - Zip Code:96753-8180
Practice Address - Country:US
Practice Address - Phone:808-866-4245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1393103TC0700X
OR2331103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical