Provider Demographics
NPI:1215633524
Name:ORTIZ MOWERY, COURTNIE DYAN (MS, LPC)
Entity type:Individual
Prefix:MRS
First Name:COURTNIE
Middle Name:DYAN
Last Name:ORTIZ MOWERY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 S 54TH ST STE 5
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8169
Mailing Address - Country:US
Mailing Address - Phone:479-903-0070
Mailing Address - Fax:
Practice Address - Street 1:2113 S 54TH ST STE 5
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8169
Practice Address - Country:US
Practice Address - Phone:479-903-0070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-07
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP2302005101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARP2302005OtherARKANSAS BOARD OF EXAMINERS IN COUNSELING (LPC)