Provider Demographics
NPI:1205568110
Name:COURSEY, CAYLIN LEIGH (LMSW-T)
Entity type:Individual
Prefix:
First Name:CAYLIN
Middle Name:LEIGH
Last Name:COURSEY
Suffix:
Gender:F
Credentials:LMSW-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 W 22ND ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-2718
Mailing Address - Country:US
Mailing Address - Phone:785-312-0045
Mailing Address - Fax:
Practice Address - Street 1:406 S MAIN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-2334
Practice Address - Country:US
Practice Address - Phone:620-794-6123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12679104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker