Healthcare Provider Details

I. General information

NPI: 1497681977
Provider Name (Legal Business Name): ASHLEE FOWLKES PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: A.C. FOWLKES PH.D.

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 BAY AVE UNIT 4
CAPITOLA CA
95010-4500
US

IV. Provider business mailing address

826 BAY AVE UNIT 4
CAPITOLA CA
95010-4500
US

V. Phone/Fax

Practice location:
  • Phone: 831-246-6554
  • Fax:
Mailing address:
  • Phone: 831-246-6554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810005708
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: