Provider Demographics
NPI:1669632550
Name:COURSON, JERRI D (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JERRI
Middle Name:D
Last Name:COURSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JERRI
Other - Middle Name:D
Other - Last Name:TIMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2211 CHARLOTTE ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-2733
Mailing Address - Country:US
Mailing Address - Phone:816-404-5798
Mailing Address - Fax:
Practice Address - Street 1:2211 CHARLOTTE ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64108-2733
Practice Address - Country:US
Practice Address - Phone:816-404-5798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090066431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical