Basic Information
Provider Information
NPI: 1437435724
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ISAAC
FirstName: COURTNEY
MiddleName: SAMON
NamePrefix: MRS.
NameSuffix:  
Credential: LMFT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1000
Address2:  
City: BAKERSFIELD
State: CA
PostalCode: 933021000
CountryCode: US
TelephoneNumber: 6618686601
FaxNumber: 6618686666
Practice Location
Address1: 5121 STOCKDALE HWY STE 150C
Address2:  
City: BAKERSFIELD
State: CA
PostalCode: 933092656
CountryCode: US
TelephoneNumber: 6618686100
FaxNumber: 6618686100
Other Information
ProviderEnumerationDate: 10/31/2011
LastUpdateDate: 08/15/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/15/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
171M00000X  N Other Service ProvidersCase Manager/Care Coordinator 
106H00000X133567CAY Behavioral Health & Social Service ProvidersMarriage & Family Therapist 

No ID Information.


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