Provider Demographics
NPI:1043648108
Name:FOWLER, AMBER DAWN (CMHC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:DAWN
Last Name:FOWLER
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:DAWN
Other - Last Name:MALDONADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACMHC
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:GREEN RIVER
Mailing Address - State:UT
Mailing Address - Zip Code:84525-0297
Mailing Address - Country:US
Mailing Address - Phone:435-200-5551
Mailing Address - Fax:435-344-4604
Practice Address - Street 1:50 E CENTER ST STE 7
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-2473
Practice Address - Country:US
Practice Address - Phone:435-200-5551
Practice Address - Fax:435-344-4604
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-28
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8483294-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional