Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 1297 | OR |
N | 103T00000X | Psychologist | 1297 | OR |
Y | 102L00000X | Psychologist | PY 60153263 | WA |
Y | 103T00000X | Psychologist | PY 60153263 | WA |
N | 103TA0700X | Adult Development & Aging Psychologist | 1297 | OR |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 1297 | OR |
N | 103TB0200X | Cognitive & Behavioral Psychologist | PY 60153263 | WA |
N | 103G00000X | Clinical Psychologist | 1297 | OR |
N | 103TC0700X | Clinical Psychologist | 1297 | OR |
N | 103G00000X | Clinical Psychologist | PY 60153263 | WA |
N | 103TC0700X | Clinical Psychologist | PY 60153263 | WA |
N | 103TC1900X | Counseling Psychologist | 1297 | OR |
N | 103TC1900X | Counseling Psychologist | PY 60153263 | WA |
N | 103TF0000X | Family Psychologist | 1297 | OR |
N | 103TF0000X | Family Psychologist | PY 60153263 | WA |
N | 103TM1800X | Intellectual & Developmental Disabilities | 1297 | OR |
N | 103TM1800X | Intellectual & Developmental Disabilities | PY 60153263 | WA |
N | 103TP2701X | Group Psychotherapist | 1297 | OR |
N | 103TP2701X | Group Psychotherapist | PY 60153263 | WA |
NPI | 1003194564 |
---|---|
Provider Name | Dr. Bart James Fowler |
First Address | Vancouver, WA 98662-1560 |
Second Address | Vancouver, WA 98662-1560 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2011 |
Last Update Date | 02/08/2011 |