Provider Demographics
NPI:1184469637
Name:COURTNEY'S THERAPY SERVICES PLLC
Entity type:Organization
Organization Name:COURTNEY'S THERAPY SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL HEALTH THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:BURGAD-WIFALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LICSW, LMAC
Authorized Official - Phone:701-321-2175
Mailing Address - Street 1:1324 SORRENTO CIR
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-7776
Mailing Address - Country:US
Mailing Address - Phone:701-321-2175
Mailing Address - Fax:
Practice Address - Street 1:1324 SORRENTO CIR
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-7776
Practice Address - Country:US
Practice Address - Phone:701-321-2175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty