Provider Demographics
NPI:1881971810
Name:MISHOU, COURTNEY P (LMSW-CC)
Entity type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:P
Last Name:MISHOU
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 MAIN ROAD
Mailing Address - Street 2:
Mailing Address - City:BRADLEY
Mailing Address - State:ME
Mailing Address - Zip Code:04411
Mailing Address - Country:US
Mailing Address - Phone:207-299-0588
Mailing Address - Fax:
Practice Address - Street 1:254 STATE ST
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1519
Practice Address - Country:US
Practice Address - Phone:207-989-2946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC133101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical