Organization
FOWLER PSYCHOLOGICAL SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN RICHARD FOWLER PHD (PRESIDENT)
(952) 545-8833
Entity
Organization
Contact information
Practice address
5353 GAMBLE DR, 108, ST LOUIS PARK, MN 55416-1509
(952) 545-8833
(952) 224-2299
Mailing address
5353 GAMBLE DR, 108, ST LOUIS PARK, MN 55416-1509
(952) 545-8833
(952) 224-2299
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
LP1765
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
620000219
MEDICARE
MN
Enumeration date
08/12/2008
Last updated
08/12/2008
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