Provider Demographics
NPI:1770359366
Name:HAM, MARY COURTNEY (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:COURTNEY
Last Name:HAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 E THIRD ST APT 209
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-2249
Mailing Address - Country:US
Mailing Address - Phone:859-948-1159
Mailing Address - Fax:
Practice Address - Street 1:576 E THIRD ST APT 209
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2249
Practice Address - Country:US
Practice Address - Phone:859-948-1159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA111871041C0700X
KY2585861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical