Provider Demographics
NPI:1093820458
Name:FOWLER, ANGELA VALERIANO (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:VALERIANO
Last Name:FOWLER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8339 CHURCH ST
Mailing Address - Street 2:STE. 105
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-4453
Mailing Address - Country:US
Mailing Address - Phone:408-848-3331
Mailing Address - Fax:408-848-3354
Practice Address - Street 1:8339 CHURCH ST
Practice Address - Street 2:STE. 105
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-4453
Practice Address - Country:US
Practice Address - Phone:408-848-3331
Practice Address - Fax:408-848-3354
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41723106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA026287OtherVMC PIN
CA356728OtherMHN PIN