Provider Demographics
NPI:1124504329
Name:FLORES RODRIGUEZ, COURTNEY LIN
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LIN
Last Name:FLORES RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:LIN
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:1322 SAGITTARIUS ST
Mailing Address - Street 2:
Mailing Address - City:FRUITA
Mailing Address - State:CO
Mailing Address - Zip Code:81521-3035
Mailing Address - Country:US
Mailing Address - Phone:970-640-1664
Mailing Address - Fax:970-257-2401
Practice Address - Street 1:3090 N 12TH ST UNIT A
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-2804
Practice Address - Country:US
Practice Address - Phone:970-241-2212
Practice Address - Fax:970-257-2401
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLSW.0009921699104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker