Provider Demographics
NPI:1578075438
Name:KEMPER, COURTNEY RENEE (CDCA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:RENEE
Last Name:KEMPER
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 JACKSON PIKE STE 102
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-2621
Mailing Address - Country:US
Mailing Address - Phone:740-578-4824
Mailing Address - Fax:740-578-4821
Practice Address - Street 1:254 PINECREST DR
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1347
Practice Address - Country:US
Practice Address - Phone:740-578-4824
Practice Address - Fax:740-578-4821
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH164941101YA0400X
OHRN.526858163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0215362Medicaid