Provider Demographics
NPI:1043707177
Name:PATRICK, COURTNEY MARIE (MA, CRC, LPC)
Entity type:Individual
Prefix:MISS
First Name:COURTNEY
Middle Name:MARIE
Last Name:PATRICK
Suffix:
Gender:F
Credentials:MA, CRC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4012 COTTAGE PARK CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76013-8087
Mailing Address - Country:US
Mailing Address - Phone:417-343-4996
Mailing Address - Fax:
Practice Address - Street 1:1810 8TH AVE STE B
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1352
Practice Address - Country:US
Practice Address - Phone:682-207-6682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-14
Last Update Date:2018-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75449101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health