| Doctor Name: | JEREMY ANDREW COURTNEY |
| NPI Number: | 1629311915 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.S. |
| License Number: | LISAC-11472 |
| Business Practice Address: | 4712 Double A Ranch Rd. Ash Fork, AZ - 86320 |
| Business Phone Number: | 9287072393 |
| Business Fax Number: | |
| Mailing Address: | Po Box 806, ASH FORK |
| State: | AZ |
| Postal Code: | 863200806 |
| Phone Number: | 9287072393 |
| Fax Number: | |
| NPI Enumeration Date: | 04/04/2013 |
| NPI Last Update Date: | 08/16/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | LISAC-11472 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |