Healthcare Provider Details

I. General information

NPI: 1518695782
Provider Name (Legal Business Name): COURTNEY BROOKE LINDSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 INDUSTRIAL PARK RD
MAXWELTON WV
24957-8066
US

IV. Provider business mailing address

416 ROCKCLIFF RD
RUPERT WV
25984-8817
US

V. Phone/Fax

Practice location:
  • Phone: 304-250-5416
  • Fax:
Mailing address:
  • Phone: 304-250-5416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: