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General NPI Number Information
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NPI Number | 1063061380
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Entity Type | Individual
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Provider Name | BEVERLY LYNN FOWLER LPC, AADC
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Gender | Female
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Dates
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Enumeration Date | 09/09/2019
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 2337 3RD AVE N
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City | LEWISTON
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State | ID
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Zip | 83501-1625
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Country | US
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Telephone | 509-444-8200
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Fax | 509-434-0392
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Provider Business Mailing Address
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Address Line | 611 N IRON BRIDGE WAY
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City | SPOKANE
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State | WA
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Zip | 99202-4932
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Country | US
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Telephone | 509-444-8888
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Fax | 509-444-7806
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5685
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License Number State | ID
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