Basic Information
| Provider Information | |||||||||
| NPI: | 1770911059 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FOWLER | ||||||||
| FirstName: | MORGAN | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.A,. BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1210 ALDERSGATE RD | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722056606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5015743053 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1310 W SLAUGHTER LN | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787486556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883083728 | ||||||||
| FaxNumber: | 6304051747 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2013 | ||||||||
| LastUpdateDate: | 09/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-13-13720 | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.