Healthcare Provider Details

I. General information

NPI: 1205223666
Provider Name (Legal Business Name): THERESA ANN TOWLER LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 SE 124TH AVE
VANCOUVER WA
98684-6015
US

IV. Provider business mailing address

108 SE 124TH AVE
VANCOUVER WA
98684-6015
US

V. Phone/Fax

Practice location:
  • Phone: 626-376-3035
  • Fax: 360-626-7005
Mailing address:
  • Phone: 626-376-3035
  • Fax: 360-626-7005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60696394
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMG60507102
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: