Provider Demographics
NPI:1730425455
Name:COURTNEY, JAN (LPC)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4675 E COACHLIGHT LN
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-6934
Mailing Address - Country:US
Mailing Address - Phone:520-577-1004
Mailing Address - Fax:520-299-1551
Practice Address - Street 1:85 W FRANKLIN
Practice Address - Street 2:COPE COMMUNITY SERVICES
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85701
Practice Address - Country:US
Practice Address - Phone:520-624-9818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-0471101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional