Healthcare Provider Details

I. General information

NPI: 1528977352
Provider Name (Legal Business Name): COURTNEY ROY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 ENGLENOOK DR
DEBARY FL
32713-1804
US

IV. Provider business mailing address

354 ENGLENOOK DR
DEBARY FL
32713-1804
US

V. Phone/Fax

Practice location:
  • Phone: 386-518-2590
  • Fax:
Mailing address:
  • Phone: 386-518-2590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMT4684
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: