MEDICARE: BRIDGET FOWLER MA, LPC ASSOCIATE

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	101YP2500X	Professional Counselor	85073	TX

General Provider Information

NPI Number	:	1518612217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIDGET FOWLER MA, LPC ASSOCIATE

Provider Business Mailing Address
First Line	:	1509 PASADENA DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-1839
Country	:	US
Telephone Number	:	512-705-2847
Fax Number	:

Provider Business Practice Location Address
First Line	:	1621 W 6TH ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78703-5059
Country	:	US
Telephone Number	:	512-705-2847
Fax Number	:

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

Provider Enumeration Date	:	02/21/2022
Last Update Date	:	02/21/2022

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