Basic Information
| Provider Information | |||||||||
| NPI: | 1427144195 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARKINS | ||||||||
| FirstName: | COURTNEY | ||||||||
| MiddleName: | AMANDA-BALL | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 STONE PNE | ||||||||
| Address2: | |||||||||
| City: | ALISO VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926562131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9499166288 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1504 BROOKHOLLOW DR STE 111 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927055418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149571004 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 43611 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.