Healthcare Provider Details

I. General information

NPI: 1972837375
Provider Name (Legal Business Name): HEATHER FOWLER LCPC, LCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 10/30/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2386 E ASPEN HILLS PL
SANDY UT
84092-1250
US

IV. Provider business mailing address

2386 E ASPEN HILLS PL
SANDY UT
84092
US

V. Phone/Fax

Practice location:
  • Phone: 801-209-6691
  • Fax:
Mailing address:
  • Phone: 801-209-6691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number67794386009
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCP0249
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: