Provider Demographics
NPI:1912138033
Name:BOKELMAN, COURTNEY ANNE (LISW-S)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ANNE
Last Name:BOKELMAN
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10495 MONTGOMERY RD STE 20
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4420
Mailing Address - Country:US
Mailing Address - Phone:513-862-2920
Mailing Address - Fax:513-487-5685
Practice Address - Street 1:10495 MONTGOMERY RD STE 20
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-4420
Practice Address - Country:US
Practice Address - Phone:513-862-2920
Practice Address - Fax:513-487-5685
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
OHI.10000741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker