Healthcare Provider Details

I. General information

NPI: 1982569463
Provider Name (Legal Business Name): COURTNEY LONGWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 W NEW HOPE DR STE 203
CEDAR PARK TX
78613-6785
US

IV. Provider business mailing address

921 W NEW HOPE DR STE 203
CEDAR PARK TX
78613-6785
US

V. Phone/Fax

Practice location:
  • Phone: 512-887-3627
  • Fax:
Mailing address:
  • Phone: 512-887-3627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number92432
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: