Individual provider Active NPI

Bart James Fowler, PSY.D.

Psychologist
Vancouver, WA

National Provider Identifier

1003194564

Registry record updated Aug 2, 2011

On this page

Key facts
NPPES NPI Registry
Medicare participation
National Provider Directory
Organizations & group practices2
NPI Registry JSON
Other providers in Vancouver, WA
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: PsychologistTaxonomy code 103T00000X
License: PY 60153263 Issued in WA
Practice address: 11802 NE 117TH Ave
Vancouver, WA 98662-1560
Phone: (360) 891-2000
Fax: (360) 944-6965
NPI assigned: Aug 1, 2011
Sex: Male
Sole proprietor: No

NPPES NPI Registry

Updated by the provider on Aug 2, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 15

Specialty (taxonomy)	Code	License	State	Primary
Cognitive & Behavioral Psychologist	103TB0200X	1297	OR
Cognitive & Behavioral Psychologist	103TB0200X	PY 60153263	WA
Group Psychotherapy Psychologist	103TP2701X	1297	OR
Group Psychotherapy Psychologist	103TP2701X	PY 60153263	WA
Adult Development & Aging Psychologist	103TA0700X	1297	OR
Psychologist	103T00000X	1297	OR
Psychologist	103T00000X	PY 60153263	WA	Primary
Clinical Psychologist	103TC0700X	1297	OR
Clinical Psychologist	103TC0700X	PY 60153263	WA
Counseling Psychologist	103TC1900X	1297	OR
Counseling Psychologist	103TC1900X	PY 60153263	WA
Family Psychologist	103TF0000X	1297	OR
Family Psychologist	103TF0000X	PY 60153263	WA
Intellectual & Developmental Disabilities Psychologist	103TM1800X	1297	OR
Intellectual & Developmental Disabilities Psychologist	103TM1800X	PY 60153263	WA

Addresses

Primary practice location

11802 NE 117TH Ave
Vancouver, WA 98662-1560

Mailing address

11802 NE 117TH Ave
Vancouver, WA 98662-1560
Phone (360) 891-2000

Medicare participation

Medicare enrollment files

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): Not enrolled

State licenses

License	State	Type	Specialty
PY 60153263	WA	MD	Psychologist
1297	OR	MD	Adult Development & Aging Psychologist

Practice roles

Organization	Specialty	Status	New patients
Charis Counseling Associates		Past	Accepting new patients
County of Clackamas Office of County Auditor		Past	Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Charis Counseling Associates
- Community/Behavioral Health Agency
- Vancouver, WA
- NPI 1083880801
NPD (past) Authorized official
County of Clackamas Office of County Auditor
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Milwaukie, OR
- NPI 1245269315
NPD (past)

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1312156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312243200000",
    "number": "1003194564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11802 NE 117TH AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986621560",
            "telephone_number": "360-891-2000",
            "fax_number": "360-944-6965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11802 NE 117TH AVE",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986621560",
            "telephone_number": "360-891-2000",
            "fax_number": "360-944-6965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOWLER",
        "first_name": "BART",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-01",
        "last_updated": "2011-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "OR",
            "license": "1297",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "WA",
            "license": "PY 60153263",
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "OR",
            "license": "1297",
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "WA",
            "license": "PY 60153263",
            "primary": false
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "OR",
            "license": "1297",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OR",
            "license": "1297",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "PY 60153263",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "1297",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY 60153263",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "OR",
            "license": "1297",
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "WA",
            "license": "PY 60153263",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "OR",
            "license": "1297",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "WA",
            "license": "PY 60153263",
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "OR",
            "license": "1297",
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "WA",
            "license": "PY 60153263",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.