MEDICARE: KATHERINE FOWLER LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	83611	TX
2	101YM0800X	Mental Health Counselor	83611	TX

General Provider Information

NPI Number	:	1275298200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE FOWLER LPC

Provider Business Mailing Address
First Line	:	8639 SOUTHWESTERN BLVD
Second Line	:	#223
City	:	DALLAS
State	:	TX
Zip	:	75206-8263
Country	:	US
Telephone Number	:	214-308-1484
Fax Number	:

Provider Business Practice Location Address
First Line	:	8639 SOUTHWESTERN BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-8261
Country	:	US
Telephone Number	:	214-308-1484
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2021
Last Update Date	:	05/30/2025

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