Provider Demographics
NPI:1093376212
Name:SERGENT-FOX, COURTNEY BROOKE
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:BROOKE
Last Name:SERGENT-FOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:MAYSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41056-9122
Mailing Address - Country:US
Mailing Address - Phone:606-407-2847
Mailing Address - Fax:
Practice Address - Street 1:501 DARBY CREEK RD STE 7
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1605
Practice Address - Country:US
Practice Address - Phone:606-407-2847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2540421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical