Provider Demographics
NPI:1336531367
Name:FOWLER, KATIE (LPCC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPCA
Mailing Address - Street 1:112 ALLIE YOUNG HALL
Mailing Address - Street 2:150 UNIVERSITY BLVD.
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351
Mailing Address - Country:US
Mailing Address - Phone:606-783-2055
Mailing Address - Fax:606-783-9106
Practice Address - Street 1:112 ALLIE YOUNG HALL , 150 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1684
Practice Address - Country:US
Practice Address - Phone:606-783-2055
Practice Address - Fax:606-783-9106
Is Sole Proprietor?:No
Enumeration Date:2015-02-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY172237101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100446730Medicaid