Provider Demographics
NPI:1386083806
Name:FOWLER, SARAH ROSE (LPC, MS)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:ROSE
Last Name:FOWLER
Suffix:
Gender:F
Credentials:LPC, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 E SPAULDING AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-1668
Mailing Address - Country:US
Mailing Address - Phone:719-542-0032
Mailing Address - Fax:719-296-6218
Practice Address - Street 1:44 E SPAULDING AVE STE 1
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81007-1668
Practice Address - Country:US
Practice Address - Phone:719-542-0032
Practice Address - Fax:719-296-6218
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO11456101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional