Provider Demographics
NPI:1861700510
Name:FOWLER, MELISSA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:
Last Name:FOWLER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ELIZABETH
Other - Last Name:BARTLOTTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 1831
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90637-1831
Mailing Address - Country:US
Mailing Address - Phone:562-383-1728
Mailing Address - Fax:562-309-8319
Practice Address - Street 1:15651 IMPERIAL HWY
Practice Address - Street 2:SUITE 203
Practice Address - City:LA MIRADA
Practice Address - State:CA
Practice Address - Zip Code:90638-1628
Practice Address - Country:US
Practice Address - Phone:562-383-1728
Practice Address - Fax:562-309-8319
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA334061041C0700X
101YM0800X
CA732281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health