MEDICARE: COURTNEY H MARVIN LCSW

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	LCSW-379	WY

General Provider Information

NPI Number	:	1467934216
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY H MARVIN LCSW

Provider Business Mailing Address
First Line	:	6505 FORWEAL DR
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-8875
Country	:	US
Telephone Number	:	307-690-7067
Fax Number	:

Provider Business Practice Location Address
First Line	:	6505 FORWEAL DR
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83001-8875
Country	:	US
Telephone Number	:	307-690-7067
Fax Number	:

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

Provider Enumeration Date	:	08/29/2018
Last Update Date	:	04/09/2026

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