Basic Information
Provider Information
NPI: 1376771469
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HOTTINGER
FirstName: COURTNEY
MiddleName: L
NamePrefix: MRS.
NameSuffix:  
Credential: LMFT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 12625 HESPERIA RD
Address2:  
City: VICTORVILLE
State: CA
PostalCode: 923957720
CountryCode: US
TelephoneNumber: 7605525545
FaxNumber:  
Practice Location
Address1: 11951 HESPERIA RD
Address2:  
City: HESPERIA
State: CA
PostalCode: 923451855
CountryCode: US
TelephoneNumber: 7609562345
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/26/2009
LastUpdateDate: 01/29/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/29/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
106H00000X  Y Behavioral Health & Social Service ProvidersMarriage & Family Therapist 

No ID Information.


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