Provider Demographics
NPI:1245877604
Name:COURTNEY, AUBREY ROSE
Entity type:Individual
Prefix:MRS
First Name:AUBREY
Middle Name:ROSE
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AUBREY
Other - Middle Name:ROSE
Other - Last Name:PIPKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:921 S BOULDER AVE
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-6523
Mailing Address - Country:US
Mailing Address - Phone:575-749-6285
Mailing Address - Fax:
Practice Address - Street 1:921 S BOULDER AVE
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-6523
Practice Address - Country:US
Practice Address - Phone:575-749-6285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician