Provider Demographics
NPI:1033260849
Name:FOWLER, WILLIAM E (PHD, MP)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:E
Last Name:FOWLER
Suffix:
Gender:M
Credentials:PHD, MP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 OLD SPANISH TRL
Mailing Address - Street 2:#203
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-8601
Mailing Address - Country:US
Mailing Address - Phone:985-781-0548
Mailing Address - Fax:888-414-4319
Practice Address - Street 1:3351 SEVERN AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-7414
Practice Address - Country:US
Practice Address - Phone:504-975-1659
Practice Address - Fax:504-288-0091
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA665103TC2200X
LAMP000033103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5T030Medicare ID - Type Unspecified