Provider Demographics
NPI:1043608797
Name:COURTNEY, JENNIFER BOOTH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BOOTH
Last Name:COURTNEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:MT WASHINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40047-7757
Mailing Address - Country:US
Mailing Address - Phone:502-538-1000
Mailing Address - Fax:502-538-1100
Practice Address - Street 1:1925 FREDERICA ST STE 200
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-4818
Practice Address - Country:US
Practice Address - Phone:270-926-2484
Practice Address - Fax:270-685-6015
Is Sole Proprietor?:No
Enumeration Date:2015-01-05
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY71961041C0700X
KY2538691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100577710Medicaid