Healthcare Provider Details

I. General information

NPI: 1710365580
Provider Name (Legal Business Name): DANIEL FOWLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 N LOCUST AVE
LAWRENCEBURG TN
38464-3757
US

IV. Provider business mailing address

45 ADDIMACK CV
BELLS TN
38006-2400
US

V. Phone/Fax

Practice location:
  • Phone: 931-762-7232
  • Fax: 931-762-7234
Mailing address:
  • Phone: 731-961-1796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6295
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: