Provider Demographics
NPI:1083382808
Name:MCCOURT, JEREMY ADAM (LMSW)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:ADAM
Last Name:MCCOURT
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5927 SIMON CT SW
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49418-9795
Mailing Address - Country:US
Mailing Address - Phone:616-214-1992
Mailing Address - Fax:
Practice Address - Street 1:5927 SIMON CT SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49418-9795
Practice Address - Country:US
Practice Address - Phone:616-214-1992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-06
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801097230104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker