Healthcare Provider Details

I. General information

NPI: 1851707426
Provider Name (Legal Business Name): MS. COURTNEY M PERRITT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. COURTNEY M JOHNSON

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8092 ROSE LN
GOODRICH MI
48438-9207
US

IV. Provider business mailing address

8092 ROSE LN
GOODRICH MI
48438-9207
US

V. Phone/Fax

Practice location:
  • Phone: 248-660-6289
  • Fax:
Mailing address:
  • Phone: 248-660-6289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801108699
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: