Provider Demographics
NPI:1467570499
Name:FOWLER, TAMMY LYNN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:LYNN
Last Name:FOWLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:LYNN
Other - Last Name:DYAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCW
Mailing Address - Street 1:229 W COE DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4503
Mailing Address - Country:US
Mailing Address - Phone:405-501-8029
Mailing Address - Fax:
Practice Address - Street 1:229 W COE DR
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4503
Practice Address - Country:US
Practice Address - Phone:405-501-8029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK27561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical