Provider Demographics
NPI:1659117497
Name:SMITH, COURTNEY
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16069 TOWNSHIP ROAD 39
Mailing Address - Street 2:
Mailing Address - City:BELLE CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43310-9620
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16069 TOWNSHIP ROAD 39
Practice Address - Street 2:
Practice Address - City:BELLE CENTER
Practice Address - State:OH
Practice Address - Zip Code:43310-9620
Practice Address - Country:US
Practice Address - Phone:937-441-5317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health