Cortney Dawn Bautista, MS, LAC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

LAC-20765 Issued in AZ

Practice address

2215 Hualapai Mountain Rd
Kingman, AZ 86401-8324

Phone

(928) 753-9387

NPI assigned

Sep 4, 2024

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 4, 2024.

{
    "created_epoch": "1725408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725408000000",
    "number": "1245065895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2215 HUALAPAI MOUNTAIN RD",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864018324",
            "telephone_number": "928-753-9387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2215 HUALAPAI MOUNTAIN RD",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864018324",
            "telephone_number": "928-753-9387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "CORTNEY",
        "middle_name": "DAWN",
        "name_prefix": "Mrs.",
        "credential": "MS, LAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-04",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AZ",
            "license": "LAC-20765",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Earlene Barneycastle, MD
• Kaylene Barrus, P.T.
• Nathan Ray Bartholomew, DO
• Anne Marie Bathauer, MASTERS OF EDUCATION
• Battle Born Anesthesia Associates LTD
• Mary Lee Beck, NP
• Jacob Daniel Beckstrand, DDS
• Brent J Bedke, MD
• Scott A Bell, RPH
• Blair Glee Berg, P.T.

• All providers in Kingman, AZ
• Mental Health Counselor in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.