Provider Demographics
NPI:1841311982
Name:FOWLER, JONI MARIE (LPC)
Entity type:Individual
Prefix:MRS
First Name:JONI
Middle Name:MARIE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 1 BOX 160
Mailing Address - Street 2:
Mailing Address - City:ROFF
Mailing Address - State:OK
Mailing Address - Zip Code:74865-9763
Mailing Address - Country:US
Mailing Address - Phone:580-456-7873
Mailing Address - Fax:
Practice Address - Street 1:1308 CRADDUCK RD
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-8442
Practice Address - Country:US
Practice Address - Phone:580-332-3699
Practice Address - Fax:580-421-9828
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1869101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health