Healthcare Provider Details

I. General information

NPI: 1679482715
Provider Name (Legal Business Name): AMY FOWLER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3348 PEDEN RD STE 501
FORT WORTH TX
76179-5508
US

IV. Provider business mailing address

808 BACK WOOD CT
AZLE TX
76020-6741
US

V. Phone/Fax

Practice location:
  • Phone: 817-239-9996
  • Fax:
Mailing address:
  • Phone: 817-239-9996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number94732
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: