Provider Demographics
NPI:1447054291
Name:EIDLE, COURTNEY LYNN
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LYNN
Last Name:EIDLE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 BRIDGE ST APT 2404
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-3695
Mailing Address - Country:US
Mailing Address - Phone:484-347-5281
Mailing Address - Fax:
Practice Address - Street 1:20 N FRONT ST
Practice Address - Street 2:
Practice Address - City:BALLY
Practice Address - State:PA
Practice Address - Zip Code:19503-9605
Practice Address - Country:US
Practice Address - Phone:267-461-8831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAPC001123101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional