Doctor Name: | MRS. LISA MICHELLE COURTNEY |
NPI Number: | 1194917203 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PROVIDER |
License Number: | |
Business Practice Address: | 2508 Central Ave Cody, WY - 824149797 |
Business Phone Number: | 3075274616 |
Business Fax Number: | |
Mailing Address: | Po Box 2081, CODY |
State: | WY |
Postal Code: | 824142081 |
Phone Number: | 3075274616 |
Fax Number: | |
NPI Enumeration Date: | 08/13/2007 |
NPI Last Update Date: | 08/13/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 385HR2060X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Respite Care Facility |
Taxonomy Classification: | Respite Care |
Taxonomy Specialization: | Respite Care, Mental Retardation and/or Developmental Disabilities, Child |
Taxonomy Definition: | A facility or distinct part of a facility that provides short term, residential care to children, diagnosed with mental retardation and/or developmental disabilities as respite for the regular caregivers. |