Provider Demographics
NPI:1992113781
Name:DEBOER, KOURTNEY MARIE (LMFT)
Entity type:Individual
Prefix:
First Name:KOURTNEY
Middle Name:MARIE
Last Name:DEBOER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KOURTNEY
Other - Middle Name:MARIE
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4412 ARABY CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7708
Mailing Address - Country:US
Mailing Address - Phone:667-285-8488
Mailing Address - Fax:
Practice Address - Street 1:4412 ARABY CHURCH RD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-7708
Practice Address - Country:US
Practice Address - Phone:667-285-8488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLMFT200001325106H00000X
VALMFT0717002067106H00000X
WALF60497597106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist