Provider Demographics
NPI:1942647508
Name:FOWLER, BRITTANY LEIGH (MS, LPC)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LEIGH
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5840 S MEMORIAL DR
Mailing Address - Street 2:SUITE #111
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-9023
Mailing Address - Country:US
Mailing Address - Phone:918-488-8002
Mailing Address - Fax:918-488-8028
Practice Address - Street 1:5840 S MEMORIAL DR
Practice Address - Street 2:SUITE #111
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-9023
Practice Address - Country:US
Practice Address - Phone:918-488-8002
Practice Address - Fax:918-488-8028
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-22
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health