MEDICARE: COURTNEY PRATT

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	101YM0800X	Mental Health Counselor	LPC-18306	AZ
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1760884738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY PRATT

Provider Business Mailing Address
First Line	:	1133 RAILROAD AVE
Second Line	:	SUITE 100
City	:	BELLINGHAM
State	:	WA
Zip	:	98225-5055
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 W MARIPOSA ST STE 100
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85013-2449
Country	:	US
Telephone Number	:	602-274-7318
Fax Number	:

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

Provider Enumeration Date	:	09/22/2014
Last Update Date	:	03/11/2024

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Directions to “ COURTNEY PRATT ” Practice Location

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