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1093603623 NPI number — COURTNEY LYNNE SHULTS RBT

NPI Number: 1093603623
Health Care Provider/Practitioner: COURTNEY LYNNE SHULTS RBT

Information about “1093603623” NPI (COURTNEY LYNNE SHULTS RBT) exists in 1093603623 in HTML format HTML  |  1093603623 in plain Text format TXT  |  1093603623 in PDF (Portable Document Format) PDF  |  1093603623 in an XML format XML  formats.

NPI Number : 1093603623 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1093603623",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SHULTS",
    "FirstName": "COURTNEY",
    "MiddleName": "LYNNE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "RBT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "23800 NORTHWESTERN HWY STE 190L",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SOUTHFIELD",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48075-7740",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "231-412-1582",
    "MailingAddressFaxNumber": "877-927-8461",
    "FirstLinePracticeLocationAddress": "29226 ORCHARD LAKE RD STE 100",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FARMINGTON HILLS",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48334-3046",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "248-621-8883",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/24/2025",
    "LastUpdateDate": "06/24/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "106S00000X",
        "TaxonomyName": "Behavior Technician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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