Provider Demographics
NPI:1497556211
Name:DILLON, COURTNEY
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:DILLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40387-8553
Mailing Address - Country:US
Mailing Address - Phone:606-602-8102
Mailing Address - Fax:
Practice Address - Street 1:358 CHRISTY CRK
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-9660
Practice Address - Country:US
Practice Address - Phone:877-498-0319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician