MEDICARE: FOWLER & TIDWELL COUNSELING, 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		TX

General Provider Information

NPI Number	:	1770942989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FOWLER & TIDWELL COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	7155 OLD KATY RD STE S215
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-2267
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7155 OLD KATY RD STE S215
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77024-2267
Country	:	US
Telephone Number	:	832-831-8379
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JENAI D TIDWELL
Credential	:	LPC
Telephone Number	:	832-831-8379

Provider Enumeration Date	:	02/16/2016
Last Update Date	:	02/16/2016

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