Provider Demographics
NPI:1609606862
Name:CROSSLAND, COURTNEY RAYNE
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:RAYNE
Last Name:CROSSLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 CYPRESS CREEK RD APT 129
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70123-6048
Mailing Address - Country:US
Mailing Address - Phone:504-401-2252
Mailing Address - Fax:
Practice Address - Street 1:4613 FAIRFIELD ST
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2742
Practice Address - Country:US
Practice Address - Phone:504-544-0740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician