Provider Demographics
NPI:1386189488
Name:LESE-FOWLER, KAREN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:LESE-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 1:3990 OLD TOWN AVENUE
Mailing Address - Street 2:SUITE A208
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3735
Mailing Address - Country:US
Mailing Address - Phone:619-764-6516
Mailing Address - Fax:619-764-6516
Practice Address - Street 1:3990 OLD TOWN AVE
Practice Address - Street 2:SUITE A208
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-2930
Practice Address - Country:US
Practice Address - Phone:619-764-6516
Practice Address - Fax:619-880-5950
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-27
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16282103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling