Provider Demographics
NPI:1285443994
Name:HAVELIND, COURTNEY KATHERINE
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:KATHERINE
Last Name:HAVELIND
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 1:4619 W ROLLING ROCK DR
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-1414
Mailing Address - Country:US
Mailing Address - Phone:714-931-9705
Mailing Address - Fax:
Practice Address - Street 1:42104 N VENTURE DR STE B105
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3823
Practice Address - Country:US
Practice Address - Phone:714-931-9705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-22725101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health