Healthcare Provider Details

I. General information

NPI: 1730528993
Provider Name (Legal Business Name): COURTNEY COLE WHITAKER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3247 S MARYLAND PKWY
LAS VEGAS NV
89109-2412
US

IV. Provider business mailing address

1250 WIGWAM PKWY UNIT 7201
HENDERSON NV
89074-8361
US

V. Phone/Fax

Practice location:
  • Phone: 702-776-3500
  • Fax: 725-201-3314
Mailing address:
  • Phone: 702-379-3890
  • 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 Code101YP2500X
TaxonomyProfessional Counselor
License NumberCI1245
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: