MEDICARE: PAUL OWEN COURTLAND SOPER LCSW-S, LISW-S, CCTP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	61803	TX
2	1041C0700X	Clinical Social Worker	CSW.09926912	CO
3	1041C0700X	Clinical Social Worker	I.1800786	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457859001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL OWEN COURTLAND SOPER LCSW-S, LISW-S, CCTP

Provider Business Mailing Address
First Line	:	PO BOX 12501
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-0501
Country	:	US
Telephone Number	:	513-207-4024
Fax Number	:

Provider Business Practice Location Address
First Line	:	3827 PAXTON AVE APT 641
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45209-2417
Country	:	US
Telephone Number	:	513-207-4024
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/29/2018
Last Update Date	:	06/26/2021

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Directions to “ PAUL OWEN COURTLAND SOPER LCSW-S, LISW-S, CCTP” Practice Location

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