Provider Demographics
NPI:1366017154
Name:CAUDILL, COURTNEY P (LMSW)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:P
Last Name:CAUDILL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5233 TOWER TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-6039
Mailing Address - Country:US
Mailing Address - Phone:512-934-4653
Mailing Address - Fax:
Practice Address - Street 1:5233 TOWER TRL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-6039
Practice Address - Country:US
Practice Address - Phone:512-934-4653
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX515651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical