Provider Demographics
NPI:1891545349
Name:BAIN, COURTNEY LEE (MA, LMHC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LEE
Last Name:BAIN
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-6006
Mailing Address - Country:US
Mailing Address - Phone:765-461-6717
Mailing Address - Fax:
Practice Address - Street 1:7002 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4057
Practice Address - Country:US
Practice Address - Phone:317-683-0031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39004902A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health