MEDICARE: COURTNEY NOEL JACKSON MATTHEWS LMSW, 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	15994	LA
2	171M00000X	Case Manager/Care Coordinator		LA
3	104100000X	Social Worker

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	:	1619548609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY NOEL JACKSON MATTHEWS LMSW, LCSW

Provider Business Mailing Address
First Line	:	755 E MOUNT PLEASANT RD
Second Line	:
City	:	ZACHARY
State	:	LA
Zip	:	70791-7804
Country	:	US
Telephone Number	:	225-304-2108
Fax Number	:

Provider Business Practice Location Address
First Line	:	755 E MOUNT PLEASANT RD
Second Line	:
City	:	ZACHARY
State	:	LA
Zip	:	70791-7804
Country	:	US
Telephone Number	:	225-503-8817
Fax Number	:

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

Provider Enumeration Date	:	07/09/2021
Last Update Date	:	01/08/2026

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