Provider Demographics
NPI:1588247878
Name:WENGER, COURTNEY ELIZABETH (MA, LBS)
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:ELIZABETH
Last Name:WENGER
Suffix:
Gender:F
Credentials:MA, LBS
Other - Prefix:MS
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:SHAUB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:102 RADCLIFFE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST LAWN
Mailing Address - State:PA
Mailing Address - Zip Code:19609-2124
Mailing Address - Country:US
Mailing Address - Phone:484-529-1410
Mailing Address - Fax:
Practice Address - Street 1:450 S 5TH ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19602-2642
Practice Address - Country:US
Practice Address - Phone:610-372-5645
Practice Address - Fax:610-898-9229
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BH005069101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor