Provider Demographics
NPI:1992115620
Name:BARR, COURTNEY M (LAC)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:M
Last Name:BARR
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29018 CANYON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TRABUCO CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:92679-1037
Mailing Address - Country:US
Mailing Address - Phone:949-354-8523
Mailing Address - Fax:
Practice Address - Street 1:27001 LA PAZ RD STE 430B
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5539
Practice Address - Country:US
Practice Address - Phone:949-354-8523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-02
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16084171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist