Provider Demographics
NPI:1538193776
Name:CALKINS, COURTNEY CHARLES (LMFT)
Entity type:Individual
Prefix:MR
First Name:COURTNEY
Middle Name:CHARLES
Last Name:CALKINS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 RIDGECREST LN
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-1384
Mailing Address - Country:US
Mailing Address - Phone:530-624-9693
Mailing Address - Fax:
Practice Address - Street 1:616 RIDGECREST LN
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-1384
Practice Address - Country:US
Practice Address - Phone:530-624-9693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42004106H00000X
TNLMT0000001845106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist