Healthcare Provider Details

I. General information

NPI: 1609658681
Provider Name (Legal Business Name): COURTNEY L WELLS RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 AZALEA RD
MOBILE AL
36609-1515
US

IV. Provider business mailing address

669 AZALEA RD
MOBILE AL
36609-1515
US

V. Phone/Fax

Practice location:
  • Phone: 251-422-1827
  • Fax: 251-340-2067
Mailing address:
  • Phone: 251-340-2020
  • Fax: 251-340-2067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-304107
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: