Provider Demographics
NPI:1699491134
Name:FOWLER, PAUL FERNANDO (LMSW)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:FERNANDO
Last Name:FOWLER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 S RIDGE RD APT 9106
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-2581
Mailing Address - Country:US
Mailing Address - Phone:504-931-0778
Mailing Address - Fax:
Practice Address - Street 1:2301 ELDORADO PKWY STE 150
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-1856
Practice Address - Country:US
Practice Address - Phone:469-215-0314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX653901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical