Provider Demographics
NPI:1306148572
Name:GALE, COURTNEY A (LCSW)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:A
Last Name:GALE
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:PO BOX 849
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-0849
Mailing Address - Country:US
Mailing Address - Phone:207-712-2350
Mailing Address - Fax:
Practice Address - Street 1:205 NELSON DRIVE
Practice Address - Street 2:UNIT 8
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-0849
Practice Address - Country:US
Practice Address - Phone:307-699-5567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY4401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical