Provider Demographics
NPI:1457444762
Name:FOWLER COOPER LMFT PA
Entity Type:Organization
Organization Name:FOWLER COOPER LMFT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FOWLER
Authorized Official - Middle Name:FAINE
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:828-264-9222
Mailing Address - Street 1:895 STATE FARM RD
Mailing Address - Street 2:STE 210
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607
Mailing Address - Country:US
Mailing Address - Phone:828-264-9222
Mailing Address - Fax:828-264-1725
Practice Address - Street 1:895 STATE FARM RD
Practice Address - Street 2:STE 210
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607
Practice Address - Country:US
Practice Address - Phone:828-264-9222
Practice Address - Fax:828-264-1725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC689106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105038Medicaid