Provider Demographics
NPI:1114906401
Name:FOWLER, JOYCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N MCKINLEY ST
Mailing Address - Street 2:STE. 500
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-3013
Mailing Address - Country:US
Mailing Address - Phone:501-664-6632
Mailing Address - Fax:501-664-1441
Practice Address - Street 1:415 N MCKINLEY ST
Practice Address - Street 2:STE. 500
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-3013
Practice Address - Country:US
Practice Address - Phone:501-664-6632
Practice Address - Fax:501-664-1441
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR03-13P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR56230OtherBLUE CROSS & BLUE SHIELD
AR56230 (C979)Medicare ID - Type UnspecifiedMEDICARE
ARQ09887Medicare UPIN