Provider Demographics
NPI:1740840438
Name:FOWLER, COURTNEY (LPC, LCDC, CRC)
Entity type:Individual
Prefix:MS
First Name:COURTNEY
Middle Name:
Last Name:FOWLER
Suffix:
Gender:
Credentials:LPC, LCDC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 141711
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78714-1711
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 TILLERY ST STE 12
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-3751
Practice Address - Country:US
Practice Address - Phone:512-703-0756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-16
Last Update Date:2025-04-27
Deactivation Date:2020-04-27
Deactivation Code:
Reactivation Date:2025-04-25
Provider Licenses
StateLicense IDTaxonomies
TX14879101YA0400X
00306515225C00000X
TX84573101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor