Provider Demographics
NPI:1023609070
Name:FOWLER-GALLOWAY, NIA (LMFT)
Entity type:Individual
Prefix:
First Name:NIA
Middle Name:
Last Name:FOWLER-GALLOWAY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50207
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84605-0207
Mailing Address - Country:US
Mailing Address - Phone:702-659-9043
Mailing Address - Fax:801-877-0864
Practice Address - Street 1:2538 ANTHEM VILLAGE DR STE 135
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5561
Practice Address - Country:US
Practice Address - Phone:702-659-9043
Practice Address - Fax:801-877-0864
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4649106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist