Provider Demographics
NPI:1578221842
Name:NOLEN, COURTNEY (LCSW, LISW)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:NOLEN
Suffix:
Gender:F
Credentials:LCSW, LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1643 NW 136TH AVE BLDG H
Mailing Address - Street 2:SUITE 100 MSC 11607-0001
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2857
Mailing Address - Country:US
Mailing Address - Phone:954-377-2939
Mailing Address - Fax:
Practice Address - Street 1:1145 FRANK ST
Practice Address - Street 2:
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-2421
Practice Address - Country:US
Practice Address - Phone:954-377-2939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-200011041C0700X
IL149.0245501041C0700X
IA1124271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical