Healthcare Provider Details

I. General information

NPI: 1326125931
Provider Name (Legal Business Name): DENISE F FOWLER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8626 AIRWAYS BLVD
SOUTHAVEN MS
38671-2603
US

IV. Provider business mailing address

132 SANDALWOOD ST
LUFKIN TX
75904-0449
US

V. Phone/Fax

Practice location:
  • Phone: 662-772-5937
  • Fax: 662-772-5940
Mailing address:
  • Phone: 936-404-2662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number51247
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: