Provider Demographics
NPI:1861805715
Name:HOLBROOK, COURTNEY (DOULA)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:HOLBROOK
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5526 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9246
Mailing Address - Country:US
Mailing Address - Phone:231-758-7244
Mailing Address - Fax:
Practice Address - Street 1:5526 CHERRY LN
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-9246
Practice Address - Country:US
Practice Address - Phone:231-758-7244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5202007817224Z00000X
MI374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant