1336406883 NPI number — RUTH CHANCEY BOWEN EDS, LPC, NCC

Table of content: RUTH CHANCEY BOWEN EDS, LPC, NCC (NPI 1336406883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336406883 NPI number — RUTH CHANCEY BOWEN EDS, LPC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOWEN
Provider First Name:
RUTH
Provider Middle Name:
CHANCEY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
EDS, LPC, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHANCEY
Provider Other First Name:
RUTH
Provider Other Middle Name:
ERIN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336406883
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/25/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2440 SANDY PLAINS RD
Provider Second Line Business Mailing Address:
BUILDING 13, SUITE 300
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30066-7217
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-971-9311
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2440 SANDY PLAINS RD
Provider Second Line Business Practice Location Address:
BUILDING 13, SUITE 300
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30066-7217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-971-9311
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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