MEDICARE: ROBERT TOWNLEY LPC, CRC

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	101Y00000X	Counselor	73838	TX

General Provider Information

NPI Number	:	1568943983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT TOWNLEY LPC, CRC

Provider Business Mailing Address
First Line	:	5905 PLUM ST
Second Line	:
City	:	WATAUGA
State	:	TX
Zip	:	76148-3461
Country	:	US
Telephone Number	:	817-988-8912
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 MERCANTILE PLAZA DR STE 307
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76137-4230
Country	:	US
Telephone Number	:	817-232-9400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2018
Last Update Date	:	08/23/2018

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