Provider Demographics
NPI:1447384557
Name:FOWLER, KRISTI JEAN (LMFT)
Entity type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:JEAN
Last Name:FOWLER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1166 EASTRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-7964
Mailing Address - Country:US
Mailing Address - Phone:208-731-0558
Mailing Address - Fax:
Practice Address - Street 1:140 RIVER VISTA PL
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-3056
Practice Address - Country:US
Practice Address - Phone:208-732-0405
Practice Address - Fax:208-732-0407
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT-3585106H00000X
CAMFC 37523106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID11653580OtherCAQH
ID000010155785OtherREGENCE BLUE SHIELD
ID2349596OtherCIGNA
ID000007224OtherUNITED BEHAVIORAL HEALTH
IDQ7411OtherBLUE CROSS OF IDAHO