MEDICARE: TERESA FOWLER

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	225C00000X	Rehabilitation Counselor	6401009621	MI
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1629748421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA FOWLER

Provider Business Mailing Address
First Line	:	15173 NORTH RD
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-1381
Country	:	US
Telephone Number	:	810-428-7909
Fax Number	:

Provider Business Practice Location Address
First Line	:	15173 NORTH RD
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-1381
Country	:	US
Telephone Number	:	810-428-7909
Fax Number	:

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

Provider Enumeration Date	:	09/14/2021
Last Update Date	:	03/06/2025

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Directions to “ TERESA FOWLER ” Practice Location

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