Provider Demographics
NPI:1558641142
Name:FOWKES, KRISTYN M (PHD)
Entity Type:Individual
Prefix:
First Name:KRISTYN
Middle Name:M
Last Name:FOWKES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KRISTYN
Other - Middle Name:M
Other - Last Name:FOWKES-MUTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:UC SANTA BARBARA STUDENT HEALTH
Mailing Address - Street 2:BUILDING 588, MC 7002
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93106-7002
Mailing Address - Country:US
Mailing Address - Phone:805-893-3087
Mailing Address - Fax:
Practice Address - Street 1:UC SANTA BARBARA STUDENT HEALTH
Practice Address - Street 2:BUILDING 588, MC 7002
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93106-7002
Practice Address - Country:US
Practice Address - Phone:805-893-3087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22826103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling