Provider Demographics
NPI:1316771488
Name:COURVILLE, JENNA NICOLE
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:NICOLE
Last Name:COURVILLE
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 1:7108 S KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7462
Mailing Address - Country:US
Mailing Address - Phone:885-832-6727
Mailing Address - Fax:772-675-9100
Practice Address - Street 1:139 JAMES COMEAUX RD STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-3376
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:772-672-9100
Is Sole Proprietor?:No
Enumeration Date:2024-08-29
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician