Provider Demographics
NPI:1487673067
Name:FOWLER, HEATHER LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:LYNN
Last Name:FOWLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 PARK AVE.
Mailing Address - Street 2:PO BOX 316
Mailing Address - City:WOOLRICH
Mailing Address - State:PA
Mailing Address - Zip Code:17779
Mailing Address - Country:US
Mailing Address - Phone:570-502-5989
Mailing Address - Fax:
Practice Address - Street 1:302 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:AVIS
Practice Address - State:PA
Practice Address - Zip Code:17721-8901
Practice Address - Country:US
Practice Address - Phone:570-502-5989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004114101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional