Provider Demographics
NPI:1326672247
Name:FOWLER, DAMIAN PAUL (LMFT)
Entity Type:Individual
Prefix:
First Name:DAMIAN
Middle Name:PAUL
Last Name:FOWLER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7981 COMSTOCK CIR
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1818
Mailing Address - Country:US
Mailing Address - Phone:404-431-6536
Mailing Address - Fax:
Practice Address - Street 1:16700 VALLEY VIEW AVE
Practice Address - Street 2:
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-5830
Practice Address - Country:US
Practice Address - Phone:949-424-7747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-29
Last Update Date:2020-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT113213106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist