Provider Demographics
NPI:1689568974
Name:DARROUGH, COURTNEY MACKILLOP
Entity type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:MACKILLOP
Last Name:DARROUGH
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 1:501 MARIN ST STE 225
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-4301
Mailing Address - Country:US
Mailing Address - Phone:805-379-1401
Mailing Address - Fax:805-379-1491
Practice Address - Street 1:501 MARIN ST STE 225
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4301
Practice Address - Country:US
Practice Address - Phone:805-379-1401
Practice Address - Fax:805-379-1491
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty