Individual provider Active NPI

Courtney Lynn Bish, MSW, LICSW

  • Clinical Social Worker
  • Saint Clairsville, OH
National Provider Identifier
1609305358
Registry record updated May 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
BP00944974 Issued in WV
Practice address
68353 Bannock Rd
Saint Clairsville, OH 43950-9736
Phone
(740) 695-7733
NPI assigned
Jun 7, 2017
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 4, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X BP00944974 WV
Clinical Social Worker 1041C0700X 2102880 OH
Clinical Social Worker 1041C0700X BP00944974 WV Primary
Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 104100000X 2102880 OH

Addresses

Primary practice location

68353 Bannock Rd
Saint Clairsville, OH 43950-9736

Mailing address

68353 Bannock Rd
Saint Clairsville, OH 43950-9736
Phone (740) 695-7733

Other names 1

  • Courtney Lynn Bolton Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240904003350 OH Practitioner - Mental Health Counselor 8527508670 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2102880OHMDClinical Social Worker
BP00944974WVMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Southeast, Inc Multi-Specialty CurrentSince Jun 8, 2024 Accepting new patients
Southeast, Inc CurrentSince Jun 8, 2024 Accepting new patients

Locations

16 W Long St
Columbus, OH 43215

68353 Bannock Uniontown Rd
St Clairsvle, OH 43950
Phone (740) 695-9344

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1496793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683158400000",
    "number": "1609305358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "68353 BANNOCK RD",
            "city": "SAINT CLAIRSVILLE",
            "state": "OH",
            "postal_code": "439509736",
            "telephone_number": "740-695-7733",
            "fax_number": "740-695-7787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "68353 BANNOCK RD",
            "city": "SAINT CLAIRSVILLE",
            "state": "OH",
            "postal_code": "439509736",
            "telephone_number": "740-695-7733"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BISH",
        "first_name": "COURTNEY",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "MSW, LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-06-07",
        "last_updated": "2023-05-04",
        "certification_date": "2023-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WV",
            "license": "BP00944974",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "2102880",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WV",
            "license": "BP00944974",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": "OH",
            "license": "2102880",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COURTNEY",
            "last_name": "BOLTON",
            "middle_name": "LYNN",
            "credential": "MSW,LICSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Saint Clairsville, OH

Sources for this page

Verify at the official NPI Registry.