Healthcare Provider Details

I. General information

NPI: 1548921885
Provider Name (Legal Business Name): COURTNEY LYNN HALSTED RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2022
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 FOREST POINT CIR # 140
CHARLOTTE NC
28273-5793
US

IV. Provider business mailing address

4575 SE DIXIE HWY
STUART FL
34997-6826
US

V. Phone/Fax

Practice location:
  • Phone: 980-529-7088
  • Fax:
Mailing address:
  • Phone: 855-832-6727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-71662
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: