Individual
MICHELLE LYN PENFIELD FOWLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LAC
Contact information
Practice address
3048 E BASELINE RD STE 107, MESA, AZ 85204-7287
(480) 779-9155
Mailing address
4132 E JUANITA AVE, GILBERT, AZ 85234-0344
(480) 779-9155
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LAC-17978
AZ
Other
Enumeration date
09/10/2019
Last updated
09/10/2019
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