Basic Information
Provider Information | |||||||||
NPI: | 1497170179 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | RITCHIE | ||||||||
FirstName: | COURTNEY | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | RN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 24435 PLYMOUTH RD | ||||||||
Address2: | 9315 TELEGRAPH | ||||||||
City: | REDFORD | ||||||||
State: | MI | ||||||||
PostalCode: | 482391616 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3134504500 | ||||||||
FaxNumber: | 3134500404 | ||||||||
Practice Location | |||||||||
Address1: | 24435 PLYMOUTH RD | ||||||||
Address2: |   | ||||||||
City: | REDFORD | ||||||||
State: | MI | ||||||||
PostalCode: | 48239 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3134500400 | ||||||||
FaxNumber: | 3134500404 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/04/2014 | ||||||||
LastUpdateDate: | 03/04/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 4704199963 | MI | N |   | Behavioral Health & Social Service Providers | Behavioral Analyst |   | 2084B0040X | 4704199963 | MI | Y |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry | 208D00000X | 4704199963 | MI | N |   | Allopathic & Osteopathic Physicians | General Practice |   |
No ID Information.