Healthcare Provider Details

I. General information

NPI: 1245926120
Provider Name (Legal Business Name): COURTNEY JAMELLE PRATHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 09/22/2023
Certification Date: 09/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 CARNEGIE AVE BLDG A
CLEVELAND OH
44115-2641
US

IV. Provider business mailing address

2685 BEAU CT NW APT 9
CANTON OH
44708-1451
US

V. Phone/Fax

Practice location:
  • Phone: 216-298-1357
  • Fax:
Mailing address:
  • Phone: 330-245-4038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: