Healthcare Provider Details

I. General information

NPI: 1508271685
Provider Name (Legal Business Name): COURTNEY LAUDER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2014
Last Update Date: 06/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 FARBER LAKES DR
WILLIAMSVILLE NY
14221-5773
US

IV. Provider business mailing address

531 FARBER LAKES DR
WILLIAMSVILLE NY
14221-5773
US

V. Phone/Fax

Practice location:
  • Phone: 716-632-5450
  • Fax: 716-632-5327
Mailing address:
  • Phone: 716-632-5450
  • Fax: 716-632-5327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number005627
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: