Provider Demographics
NPI:1063160653
Name:AVERY, COURTNEY D SR (LLPC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:D
Last Name:AVERY
Suffix:SR
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 S LINDEN RD # 10
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5462
Mailing Address - Country:US
Mailing Address - Phone:419-610-3444
Mailing Address - Fax:810-344-9350
Practice Address - Street 1:2503 S LINDEN RD # 10
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5462
Practice Address - Country:US
Practice Address - Phone:419-610-3444
Practice Address - Fax:810-344-9350
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health