Provider Demographics
NPI:1831449230
Name:PRESTON, COURTNEY MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:MARIE
Last Name:PRESTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10907 MEMORIAL HERMANN DR STE 400
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4114
Mailing Address - Country:US
Mailing Address - Phone:281-835-4159
Mailing Address - Fax:832-243-5423
Practice Address - Street 1:2950 CULLEN BLVD STE 108
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-3922
Practice Address - Country:US
Practice Address - Phone:281-835-4159
Practice Address - Fax:832-243-5423
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-12
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP71852084N0600X, 2084N0400X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00106WOtherMEDICARE HARRIS COUNTY GRP PTAN
TX153449704OtherMEDICAID GRP TPI
D6392OtherRR MEDICARE GRP PTAN
TX0035TDOtherBCBSTX GRP PROVIDER RECORD #