Provider Demographics
NPI:1770796658
Name:COURTS, GWEN S (MA MED EDD)
Entity type:Individual
Prefix:DR
First Name:GWEN
Middle Name:S
Last Name:COURTS
Suffix:
Gender:F
Credentials:MA MED EDD
Other - Prefix:DR
Other - First Name:GWEN
Other - Middle Name:
Other - Last Name:SIMPSON COURTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:12525 NEW HOPE WHITE OAK STATION RD
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45121
Mailing Address - Country:US
Mailing Address - Phone:937-444-6535
Mailing Address - Fax:937-444-6535
Practice Address - Street 1:12525 NEW HOPE WHITE OAK STATION RD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:OH
Practice Address - Zip Code:45121
Practice Address - Country:US
Practice Address - Phone:937-444-6535
Practice Address - Fax:937-444-6535
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE0001883101YP2500X
OHS0017094104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker