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General NPI Number Information
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NPI Number | 1760822027
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Entity Type | Individual
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Provider Name | JOHNATHAN L. FOWLER PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/02/2013
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 761 JUSTIN RD STE B
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City | ROCKWALL
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State | TX
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Zip | 75087-4877
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Country | US
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Telephone | 214-427-7423
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Fax |
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Provider Business Mailing Address
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Address Line | 761 JUSTIN RD STE B
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City | ROCKWALL
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State | TX
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Zip | 75087-4877
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Country | US
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Telephone | 214-427-7423
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Fax |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1262
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 36720
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License Number State | TX
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