Provider Demographics
NPI:1568290690
Name:HEALY, COURTNEY DIANE
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:DIANE
Last Name:HEALY
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 1:52 W 1800 S
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-6791
Mailing Address - Country:US
Mailing Address - Phone:435-734-2899
Mailing Address - Fax:
Practice Address - Street 1:1525 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-5638
Practice Address - Country:US
Practice Address - Phone:801-621-6510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-22
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical