MEDICARE: MRS. COURTNEY SIMONE DEFLANDERS-GRIFFIN LPC, NCC, NSCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC012561	GA

General Provider Information

NPI Number	:	1639821499
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COURTNEY SIMONE DEFLANDERS-GRIFFIN LPC, NCC, NSCS

Provider Business Mailing Address
First Line	:	13660 TARA HILLS CIR
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39503-2331
Country	:	US
Telephone Number	:	228-596-5418
Fax Number	:

Provider Business Practice Location Address
First Line	:	13660 TARA HILLS CIR
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39503-2331
Country	:	US
Telephone Number	:	228-596-5418
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2022
Last Update Date	:	01/24/2022

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