Provider Demographics
NPI:1982226130
Name:FOWLER, KATELYN ANNE (MHC-LP)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:ANNE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:ANNE
Other - Last Name:FOWLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:JAMRON COUNSELING
Mailing Address - Street 2:410 EAST JERICHO TPKE
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501
Mailing Address - Country:US
Mailing Address - Phone:516-699-2920
Mailing Address - Fax:
Practice Address - Street 1:KATIEFOWLERMHC@GMAIL.COM
Practice Address - Street 2:410 EAST JERICHO TPKE
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501
Practice Address - Country:US
Practice Address - Phone:516-699-2920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-11
Last Update Date:2020-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102427-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health