Healthcare Provider Details

I. General information

NPI: 1245825397
Provider Name (Legal Business Name): COURTNEY BLAIR SAULSMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10211 SIEGEN LN STE 2A
BATON ROUGE LA
70810-4988
US

IV. Provider business mailing address

10211 SIEGEN LN STE 2A
BATON ROUGE LA
70810-4988
US

V. Phone/Fax

Practice location:
  • Phone: 225-769-2533
  • Fax: 225-769-2441
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPLC10185
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: