Provider Demographics
NPI:1447414990
Name:FOWLER, SHELLY FRAZIER (PHD, LPC, NCC, NCSC)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:FRAZIER
Last Name:FOWLER
Suffix:
Gender:F
Credentials:PHD, LPC, NCC, NCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 S DEER CREEK DR W
Mailing Address - Street 2:
Mailing Address - City:LELAND
Mailing Address - State:MS
Mailing Address - Zip Code:38756-3132
Mailing Address - Country:US
Mailing Address - Phone:662-686-0223
Mailing Address - Fax:
Practice Address - Street 1:506 S DEER CREEK DR W
Practice Address - Street 2:
Practice Address - City:LELAND
Practice Address - State:MS
Practice Address - Zip Code:38756-3132
Practice Address - Country:US
Practice Address - Phone:662-686-0223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS995101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health