Provider Demographics
NPI:1194860999
Name:FOWLER, CHELSEA ANN (MS, LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:CHELSEA
Middle Name:ANN
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 W KEARNEY ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-2508
Mailing Address - Country:US
Mailing Address - Phone:417-848-0045
Mailing Address - Fax:417-866-2225
Practice Address - Street 1:3833 W KAY POINTE BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65802-6735
Practice Address - Country:US
Practice Address - Phone:417-848-0045
Practice Address - Fax:417-866-2225
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006034223101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO497210807Medicaid