Basic Information
| Provider Information | |||||||||
| NPI: | 1013972181 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COURTNEY | ||||||||
| FirstName: | SHERRY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LPCC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CHANNEL | ||||||||
| OtherFirstName: | SHERRY | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LPCC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4316 CARLISLE BLVD NE | ||||||||
| Address2: | SUITE D | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871074829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058372100 | ||||||||
| FaxNumber: | 5058887943 | ||||||||
| Practice Location | |||||||||
| Address1: | 4316 CARLISLE BLVD NE | ||||||||
| Address2: | SUITE D | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871074829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5058372100 | ||||||||
| FaxNumber: | 5058887943 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | X | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 2813 | NM | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.