Active NPI
Courtney Laine Wilson, LCSW
- Clinical Social Worker
- Fort Worth, TX
National Provider Identifier
1184565426
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 62204
- Practice address
- 1513 E Presidio St Ste B
Fort Worth, TX 76102-6735 - Phone
- (817) 702-7345
- Fax
- (817) 702-2950
- NPI assigned
- Apr 2, 2026
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 62204 | TX | Primary |
Addresses
Primary practice location
1513 E Presidio St Ste B
Fort Worth, TX 76102-6735
Mailing address
3821 Ashford Ave
Fort Worth, TX 76133-2935
Phone (608) 469-7336
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 62204 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1775088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1775088000000",
"number": "1184565426",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3821 ASHFORD AVE",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761332935",
"telephone_number": "608-469-7336"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1513 E PRESIDIO ST STE B",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761026735",
"telephone_number": "817-702-7345",
"fax_number": "817-702-2950"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "COURTNEY",
"middle_name": "LAINE",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2026-04-02",
"last_updated": "2026-04-02",
"certification_date": "2026-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "62204",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.