Individual provider Active NPI

Courtney Hopkins Mullaney, CCC-SLP

  • Speech-Language Pathologist
  • Southlake, TX
National Provider Identifier
1265552582
Registry record updated Aug 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
19693 Issued in TX
Practice address
1140 N Kimball Ave
Southlake, TX 76092-5569
Phone
(817) 479-7019
NPI assigned
Mar 30, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 21, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 19693 TX Primary

Addresses

Primary practice location

1140 N Kimball Ave
Southlake, TX 76092-5569

Mailing address

9301 Greble CT
Fort Worth, TX 76244-6156
Phone (817) 797-0019

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
19693TXMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Monkey Ears, LLC CurrentSince Aug 25, 2024 Accepting new patients
Green Apple LLC Current Accepting new patients
Monkey Mouths, PLLC Speech-Language Pathologist CurrentSince Aug 25, 2024 Accepting new patients

Locations

1140 N Kimball Ave
Southlake, TX 76092

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724198400000",
    "number": "1265552582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9301 GREBLE CT",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762446156",
            "telephone_number": "817-797-0019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 N KIMBALL AVE",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760925569",
            "telephone_number": "817-479-7019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLANEY",
        "first_name": "COURTNEY",
        "middle_name": "HOPKINS",
        "credential": "CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-30",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "TX",
            "license": "19693",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southlake, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 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.