Provider Demographics
NPI:1588424550
Name:BURCH, COURTNEY (LMFT)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:BURCH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 LAGUNA AVE
Mailing Address - Street 2:
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-4340
Mailing Address - Country:US
Mailing Address - Phone:786-647-9177
Mailing Address - Fax:
Practice Address - Street 1:405 LAGUNA AVE
Practice Address - Street 2:
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-4340
Practice Address - Country:US
Practice Address - Phone:786-647-9177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4845101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health