MEDICARE: FOWLER AND TIDWELL PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	69448	TX

General Provider Information

NPI Number	:	1447660295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOWLER AND TIDWELL PLLC

Provider Business Mailing Address
First Line	:	7155 OLD KATY RD
Second Line	:	SUITE S215
City	:	HOUSTON
State	:	TX
Zip	:	77024-2134
Country	:	US
Telephone Number	:	832-831-8379
Fax Number	:	832-831-8388

Provider Business Practice Location Address
First Line	:	7155 OLD KATY RD
Second Line	:	SUITE S215
City	:	HOUSTON
State	:	TX
Zip	:	77024-2134
Country	:	US
Telephone Number	:	832-831-8379
Fax Number	:	832-831-8388

Authorized Official
Title or Position	:	OWNER
Name	:	JENAI DANELLE TIDWELL
Credential	:	LPC
Telephone Number	:	317-523-9275

Provider Enumeration Date	:	05/02/2014
Last Update Date	:	04/07/2026

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