Healthcare Provider Details

I. General information

NPI: 1912227653
Provider Name (Legal Business Name): COURTNEY D BURRESS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2010
Last Update Date: 01/26/2021
Certification Date: 01/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 W SOUTHERN AVE BLDG B10
APACHE JUNCTION AZ
85120-7653
US

IV. Provider business mailing address

PO BOX 10097
CASA GRANDE AZ
85130-0020
US

V. Phone/Fax

Practice location:
  • Phone: 480-351-2850
  • Fax: 480-351-2851
Mailing address:
  • Phone: 520-836-3446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5857
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberAP9961
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: