Individual
MR. CEPHUS RONNELL FOWLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
228 BROADWAY ST, VALLEJO, CA 94590-4519
(707) 553-5331
Mailing address
1657 MORAGA DR, FAIRFIELD, CA 94534-3320
(707) 553-5331
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
MCF29966
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MFC29966
MFT LICENSE
CA
Enumeration date
12/13/2006
Last updated
07/08/2007
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