Healthcare Provider Details

I. General information

NPI: 1043648108
Provider Name (Legal Business Name): AMBER DAWN FOWLER CMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMBER DAWN MALDONADO ACMHC

II. Dates (important events)

Enumeration Date: 10/28/2013
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E CENTER ST STE 7
MOAB UT
84532-2473
US

IV. Provider business mailing address

PO BOX 297
GREEN RIVER UT
84525-0297
US

V. Phone/Fax

Practice location:
  • Phone: 435-200-5551
  • Fax: 435-344-4604
Mailing address:
  • Phone: 435-200-5551
  • Fax: 435-344-4604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8483294-6004
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: