Provider Demographics
NPI:1225648157
Name:MOLTZER, COURTNEY (M ED, LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:MOLTZER
Suffix:
Gender:F
Credentials:M ED, LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 LAKELAND PARK CIR
Mailing Address - Street 2:
Mailing Address - City:MART
Mailing Address - State:TX
Mailing Address - Zip Code:76664-5150
Mailing Address - Country:US
Mailing Address - Phone:254-231-1885
Mailing Address - Fax:
Practice Address - Street 1:951 LAKELAND PARK CIR
Practice Address - Street 2:
Practice Address - City:MART
Practice Address - State:TX
Practice Address - Zip Code:76664-5150
Practice Address - Country:US
Practice Address - Phone:254-231-1885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14937101YA0400X
TX77845101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)