Provider Demographics
NPI:1962568212
Name:COURSON, CATHERINE ANN (MSSW)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:ANN
Last Name:COURSON
Suffix:
Gender:F
Credentials:MSSW
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 96
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47111-0096
Mailing Address - Country:US
Mailing Address - Phone:502-473-7028
Mailing Address - Fax:502-688-6400
Practice Address - Street 1:4211 POPLAR LEVEL RD STE 205
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1597
Practice Address - Country:US
Practice Address - Phone:502-473-7028
Practice Address - Fax:502-688-6400
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34001110A1041C0700X
KYKY08081041C0700X
IN35000535A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8200807Medicaid
KYSWL 7942530OtherINSURANCE
IN34001110AOtherCCSW
IN35000535OtherCMFT LICENSE
044831OtherVALUE OPTIONS
090735OtherMANAGED HEALTH NETWORK
KYKY0808OtherKY LICENSE
KY000000039741OtherANTHEM
KYHUKY0277OtherCORPHEALTH
IN731070Medicare ID - Type UnspecifiedPROVIDER NUMBER
090735OtherMANAGED HEALTH NETWORK
KYKY0808OtherKY LICENSE