Healthcare Provider Details

I. General information

NPI: 1417154584
Provider Name (Legal Business Name): COURTLAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2007
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4925 CHARLESTOWN RD
NEW ALBANY IN
47150-9426
US

IV. Provider business mailing address

4925 CHARLESTOWN RD
NEW ALBANY IN
47150-9426
US

V. Phone/Fax

Practice location:
  • Phone: 812-941-9200
  • Fax: 812-941-9205
Mailing address:
  • Phone: 812-941-9200
  • Fax: 812-941-9205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number39000734A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0138
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number35001337A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number28156610A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34005525A
License Number StateIN
# 6
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01043542A
License Number StateIN

VIII. Authorized Official

Name: DR. COURTNEY E LAND
Title or Position: OWNER
Credential: D.MIN
Phone: 812-941-9200