Provider Demographics
NPI:1982809794
Name:CURTIS, CORT (PHD)
Entity Type:Individual
Prefix:DR
First Name:CORT
Middle Name:
Last Name:CURTIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7837
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92607-7837
Mailing Address - Country:US
Mailing Address - Phone:877-372-8784
Mailing Address - Fax:
Practice Address - Street 1:27601 FORBES RD
Practice Address - Street 2:SUITE 49
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1201
Practice Address - Country:US
Practice Address - Phone:877-372-8784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12900103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical