Healthcare Provider Details

I. General information

NPI: 1619548609
Provider Name (Legal Business Name): COURTNEY NOEL JACKSON MATTHEWS LMSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 E MOUNT PLEASANT RD
ZACHARY LA
70791-7804
US

IV. Provider business mailing address

755 E MOUNT PLEASANT RD
ZACHARY LA
70791-7804
US

V. Phone/Fax

Practice location:
  • Phone: 225-503-8817
  • Fax:
Mailing address:
  • Phone: 225-304-2108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15994
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: