Provider Demographics
NPI:1902372899
Name:FOWLER, CRISTINA (MSW, SWLC)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MSW, SWLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3919
Mailing Address - Country:US
Mailing Address - Phone:406-442-6950
Mailing Address - Fax:
Practice Address - Street 1:901 N HARRIS ST
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3000
Practice Address - Country:US
Practice Address - Phone:406-442-6950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-SWLC-LIC-173151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000320195Medicaid