Provider Demographics
NPI:1912183070
Name:FOWLER, BRIAN SCOTT
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:SCOTT
Last Name:FOWLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 GEORGIA ST
Mailing Address - Street 2:SUITE 355
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-5946
Mailing Address - Country:US
Mailing Address - Phone:707-558-8195
Mailing Address - Fax:
Practice Address - Street 1:301 GEORGIA ST
Practice Address - Street 2:SUITE 355
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-5946
Practice Address - Country:US
Practice Address - Phone:707-558-8195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)