Healthcare Provider Details

I. General information

NPI: 1407787468
Provider Name (Legal Business Name): COURTNEY JANE HALL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

592 KY 15 S
CAMPTON KY
41301-9552
US

IV. Provider business mailing address

592 KY 15 S
CAMPTON KY
41301-9552
US

V. Phone/Fax

Practice location:
  • Phone: 606-668-7393
  • Fax: 606-668-9701
Mailing address:
  • Phone: 606-668-7393
  • Fax: 606-668-9701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-536074
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: