Provider Demographics
NPI:1962883686
Name:MODELEWSKI, CORTNEY (LPC)
Entity type:Individual
Prefix:MS
First Name:CORTNEY
Middle Name:
Last Name:MODELEWSKI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CORTNEY
Other - Middle Name:
Other - Last Name:JEBELIAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:417 FOREST ST # 423
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49001-2747
Mailing Address - Country:US
Mailing Address - Phone:269-389-0402
Mailing Address - Fax:
Practice Address - Street 1:417 FOREST ST # 423
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49001-2747
Practice Address - Country:US
Practice Address - Phone:269-389-0402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-18
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014851101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional