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General NPI Number Information
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NPI Number | 1235829151
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Entity Type | Individual
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Provider Name | COURTNEY FRACK MS, LMLP, LMAC
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Gender | Female
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Dates
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Enumeration Date | 05/12/2023
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Last Update Date | 05/12/2023
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Provider Practice Location Address
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Address Line | 205 F ST
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City | PHILLIPSBURG
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State | KS
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Zip | 67661-1943
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Country | US
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Telephone | 785-543-9011
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Fax |
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Provider Business Mailing Address
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Address Line | 20512 US HIGHWAY 36
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City | NORTON
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State | KS
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Zip | 67654-5481
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Country | US
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Telephone | 785-543-9011
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Psychologist
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License Number | LMAC01093
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LMLP2692
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License Number State | KS
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