Individual
COURTNEY LENOREA MICKELSON MONGEON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8130 E CACTUS RD STE 510, SCOTTSDALE, AZ 85260-5263
(480) 322-6342
Mailing address
20808 N 27TH AVE APT 1233, PHOENIX, AZ 85027-3234
(608) 799-5464
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/05/2019
Last updated
03/05/2019
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