Healthcare Provider Details

I. General information

NPI: 1316874902
Provider Name (Legal Business Name): AMY FOWLER LPC-MSHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3069 BROAD ST STE 7D
CHATTANOOGA TN
37408-3083
US

IV. Provider business mailing address

109 MAPLE AVE
LOOKOUT MOUNTAIN TN
37350-1151
US

V. Phone/Fax

Practice location:
  • Phone: 423-403-4646
  • Fax:
Mailing address:
  • Phone: 601-941-1984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7092
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: