Provider Demographics
NPI:1568994663
Name:JARVIS, COURTNEY (LSW)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:
Last Name:JARVIS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 88
Mailing Address - Street 2:TOM DICK AND HARRY ALLEY
Mailing Address - City:PERRYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44864
Mailing Address - Country:US
Mailing Address - Phone:740-507-3817
Mailing Address - Fax:
Practice Address - Street 1:104 TOM DICK AND HARRY LN
Practice Address - Street 2:P.O. BOX
Practice Address - City:PERRYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44864-9558
Practice Address - Country:US
Practice Address - Phone:740-507-3817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1601093104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker