Provider Demographics
NPI:1437330271
Name:FOWLER, RICHARD ALAN (ED D)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALAN
Last Name:FOWLER
Suffix:
Gender:M
Credentials:ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15400 KNOLL TRAIL DR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-3467
Mailing Address - Country:US
Mailing Address - Phone:972-248-4673
Mailing Address - Fax:972-392-9041
Practice Address - Street 1:15400 KNOLL TRAIL DR
Practice Address - Street 2:SUITE 109
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-3467
Practice Address - Country:US
Practice Address - Phone:972-248-4673
Practice Address - Fax:972-392-9041
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03021101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional