Provider Demographics
NPI:1912048323
Name:COURTNEY, ROBERT J JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:COURTNEY
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:521 5TH AVE APT 603
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84103-2664
Mailing Address - Country:US
Mailing Address - Phone:801-581-6228
Mailing Address - Fax:801-585-6702
Practice Address - Street 1:30 N 1900 E
Practice Address - Street 2:1R52 SOM
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-2119
Practice Address - Country:US
Practice Address - Phone:801-581-6228
Practice Address - Fax:801-585-6702
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT332715-2501103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)