Individual
SHANNON K FOWLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC LICENSE NO 7745
Contact information
Practice address
6811 FAIRFIELD AVE, SHREVEPORT, LA 71106-3803
(318) 216-5088
Mailing address
8932 JEWELLA AVE, SHREVEPORT, LA 71118-2117
(318) 219-4167
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
7745
LA
101YM0800X
Mental Health Counselor
Primary
LPC7745
LA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194099259
—
LA
05
—
3156148
—
LA
Enumeration date
03/06/2012
Last updated
04/27/2023
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