Provider Demographics
NPI:1215284526
Name:VASTINE, COURTNEY (SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:VASTINE
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:VASTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SOCIAL WORKER
Mailing Address - Street 1:2639 W DALLAS ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-4100
Mailing Address - Country:US
Mailing Address - Phone:713-581-0022
Mailing Address - Fax:
Practice Address - Street 1:2639 W DALLAS ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77019-4100
Practice Address - Country:US
Practice Address - Phone:713-581-0022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-07
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1200950104100000X
TX60560104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker