Provider Demographics
NPI:1194451500
Name:ANDERSON, CORTNIE J
Entity type:Individual
Prefix:
First Name:CORTNIE
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47240-1401
Mailing Address - Country:US
Mailing Address - Phone:317-270-7237
Mailing Address - Fax:
Practice Address - Street 1:1030 N LINCOLN ST STE 2006
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240-3211
Practice Address - Country:US
Practice Address - Phone:812-651-0099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist