=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568872133
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JANE H. FOWLER, M.ED., L.P.C., P.L.L.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2014
-----------------------------------------------------
Last Update Date | 05/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7155 OLD KATY RD STE S215
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77024-2267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-639-0035
-----------------------------------------------------
Fax | 832-831-8388
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7155 OLD KATY RD STE S215
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77024-2267
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-639-0035
-----------------------------------------------------
Fax | 832-831-8388
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PROFESSIONAL COUNSELOR
-----------------------------------------------------
Name | JANE HARRINGTON FOWLER
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 281-639-0035
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 63325
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------