Basic Information
| Provider Information | |||||||||
| NPI: | 1891026548 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FOWLER | ||||||||
| FirstName: | KARMIN | ||||||||
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| Credential: | L.A.C, N.C.C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6314 N GRANITE REEF RD | ||||||||
| Address2: | |||||||||
| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852505726 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1110 E MCDOWELL RD | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850062611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6026851940 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2010 | ||||||||
| LastUpdateDate: | 01/20/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LAC-12527 | AZ | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.