Provider Demographics
NPI:1639841448
Name:GWOSDZ, COURTNEY N (RBT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:N
Last Name:GWOSDZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 TOWN LAKE CIR APT 208
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-3024
Mailing Address - Country:US
Mailing Address - Phone:817-907-8743
Mailing Address - Fax:
Practice Address - Street 1:9901 N CAPITAL OF TEXAS HWY STE 250
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5977
Practice Address - Country:US
Practice Address - Phone:512-887-2126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician