Provider Demographics
NPI:1912309006
Name:BENTLEY, COURTNEY (LSW, CAA)
Entity Type:Individual
Prefix:MISS
First Name:COURTNEY
Middle Name:
Last Name:BENTLEY
Suffix:
Gender:F
Credentials:LSW, CAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 EDALBERT DRIVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45239-7695
Mailing Address - Country:US
Mailing Address - Phone:513-741-3100
Mailing Address - Fax:513-741-5686
Practice Address - Street 1:3131 S DIXIE DR
Practice Address - Street 2:SUITE 220
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-2256
Practice Address - Country:US
Practice Address - Phone:937-643-0398
Practice Address - Fax:937-643-0398
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1303480104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker