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General NPI Number Information
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NPI Number | 1184565426
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Entity Type | Individual
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Provider Name | COURTNEY LAINE WILSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/02/2026
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Last Update Date | 04/02/2026
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Provider Practice Location Address
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Address Line | 1513 E PRESIDIO ST STE B
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City | FORT WORTH
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State | TX
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Zip | 76102-6735
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Country | US
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Telephone | 817-702-7345
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Fax | 817-702-2950
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Provider Business Mailing Address
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Address Line | 3821 ASHFORD AVE
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City | FORT WORTH
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State | TX
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Zip | 76133-2935
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Country | US
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Telephone | 608-469-7336
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 62204
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License Number State | TX
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