Provider Demographics
NPI:1265869382
Name:FOWLER, VEEDA L (MA, LCPC, LPC, NCC)
Entity type:Individual
Prefix:
First Name:VEEDA
Middle Name:L
Last Name:FOWLER
Suffix:
Gender:F
Credentials:MA, LCPC, LPC, NCC
Other - Prefix:
Other - First Name:VEEDA
Other - Middle Name:L
Other - Last Name:RINKEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2403 LITTLE ROUND TOP DR
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-3131
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1150 GRAHAM RD STE 101-102
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8077
Practice Address - Country:US
Practice Address - Phone:618-567-3815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-03
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005501101YP2500X
MO2001030203101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional