1447384557 NPI number — MRS. KRISTI JEAN FOWLER LMFT

Table of content: MR. MICHAEL JAMES GARCEAU (NPI 1972836617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447384557 NPI number — MRS. KRISTI JEAN FOWLER LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FOWLER
Provider First Name:
KRISTI
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447384557
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1166 EASTRIDGE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TWIN FALLS
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83301-7964
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-731-0558
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 RIVER VISTA PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWIN FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83301-3056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-732-0405
Provider Business Practice Location Address Fax Number:
208-732-0407
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  LMFT-3585 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: MFC 37523 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11653580 . This is a "CAQH" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010155785 . This is a "REGENCE BLUE SHIELD" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 2349596 . This is a "CIGNA" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000007224 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: Q7411 . This is a "BLUE CROSS OF IDAHO" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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