Provider Demographics
NPI:1609305358
Name:BISH, COURTNEY LYNN (MSW, LICSW)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:LYNN
Last Name:BISH
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:LYNN
Other - Last Name:BOLTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW,LICSW
Mailing Address - Street 1:68353 BANNOCK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-9736
Mailing Address - Country:US
Mailing Address - Phone:740-695-7733
Mailing Address - Fax:740-695-7787
Practice Address - Street 1:68353 BANNOCK RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIRSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43950-9736
Practice Address - Country:US
Practice Address - Phone:740-695-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-07
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00944974104100000X, 1041C0700X
OH21028801041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty