Healthcare Provider Details

I. General information

NPI: 1003065483
Provider Name (Legal Business Name): CORTNEY B WOLFE-CHRISTENSEN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 8TH AVE FL 6
FORT WORTH TX
76104-2515
US

IV. Provider business mailing address

PO BOX 99213
FORT WORTH TX
76199-0213
US

V. Phone/Fax

Practice location:
  • Phone: 682-303-0376
  • Fax: 682-303-0377
Mailing address:
  • Phone: 682-885-1860
  • Fax: 682-885-1396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6301014400
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number37538
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: