Provider Demographics
NPI:1386991818
Name:SUDDATH, COURTNEY A (LPC)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:A
Last Name:SUDDATH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11806 LEAF OAK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-5223
Mailing Address - Country:US
Mailing Address - Phone:281-807-7661
Mailing Address - Fax:
Practice Address - Street 1:11806 LEAF OAK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-5223
Practice Address - Country:US
Practice Address - Phone:281-804-0658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65150101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health