Healthcare Provider Details

I. General information

NPI: 1316409493
Provider Name (Legal Business Name): COURTNEY SYKES L9695
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 LAKEWOOD CENTER MALL # 36
LAKEWOOD CA
90712-2417
US

IV. Provider business mailing address

61 LAKEWOOD CENTER MALL # 36
LAKEWOOD CA
90712-2417
US

V. Phone/Fax

Practice location:
  • Phone: 626-714-9608
  • Fax: 562-337-3119
Mailing address:
  • Phone: 626-714-9608
  • Fax: 562-337-3119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberL9695
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: