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General NPI Number Information
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NPI Number | 1700778107
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Entity Type | Individual
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Provider Name | WILLIAM FOWLES BHCM
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Gender | Male
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Dates
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Enumeration Date | 07/18/2025
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 60 S MAIN ST STE 6
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City | TOOELE
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State | UT
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Zip | 84074-2136
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Country | US
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Telephone | 435-255-6150
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Fax | 435-938-7151
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Provider Business Mailing Address
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Address Line | 60 S MAIN ST STE 6
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City | TOOELE
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State | UT
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Zip | 84074-2136
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Country | US
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Telephone | 435-255-6150
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Fax | 435-938-7151
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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 | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | F25-119954
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License Number State | UT
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