Healthcare Provider Details

I. General information

NPI: 1033260849
Provider Name (Legal Business Name): WILLIAM E FOWLER PHD., M.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 01/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3351 SEVERN AVE SUITE 301
METAIRIE LA
70002-7414
US

IV. Provider business mailing address

2000 OLD SPANISH TRL #203
SLIDELL LA
70458-8601
US

V. Phone/Fax

Practice location:
  • Phone: 504-975-1659
  • Fax: 504-288-0091
Mailing address:
  • Phone: 985-781-0548
  • Fax: 888-414-4319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number665
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberMP000033
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: