Provider Demographics
NPI:1467731489
Name:FOWLER, DUSTIN LEIGH (PSYD, MA, MS)
Entity Type:Individual
Prefix:MRS
First Name:DUSTIN
Middle Name:LEIGH
Last Name:FOWLER
Suffix:
Gender:F
Credentials:PSYD, MA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 N MERIDIAN
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-8636
Mailing Address - Country:US
Mailing Address - Phone:714-494-3706
Mailing Address - Fax:
Practice Address - Street 1:426 N MERIDIAN
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-8636
Practice Address - Country:US
Practice Address - Phone:714-494-3706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA67378106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01245407OtherMEDICAL