Provider Demographics
NPI:1588733638
Name:SUTLIFF, COURTNEY
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:SUTLIFF
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 1:7701 W KILGORE AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:YORKTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47396-9290
Mailing Address - Country:US
Mailing Address - Phone:765-744-2103
Mailing Address - Fax:
Practice Address - Street 1:7701 W KILGORE AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:YORKTOWN
Practice Address - State:IN
Practice Address - Zip Code:47396-9290
Practice Address - Country:US
Practice Address - Phone:765-744-2103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006015A1041C0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health