Provider Demographics
NPI:1992075907
Name:COURELLI, PANAYIOTA S (PHD)
Entity type:Individual
Prefix:DR
First Name:PANAYIOTA
Middle Name:S
Last Name:COURELLI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44750 60TH STREET WEST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-7620
Mailing Address - Country:US
Mailing Address - Phone:661-729-2000
Mailing Address - Fax:
Practice Address - Street 1:44750 60TH STREET WEST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-7620
Practice Address - Country:US
Practice Address - Phone:661-729-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22491103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical