1720188287 NPI number — MRS. MARSHA L BOWMAN LPCC CLINICAL MENTAL

Table of content: MRS. MARSHA L BOWMAN LPCC CLINICAL MENTAL (NPI 1720188287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720188287 NPI number — MRS. MARSHA L BOWMAN LPCC CLINICAL MENTAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOWMAN
Provider First Name:
MARSHA
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPCC CLINICAL MENTAL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720188287
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 620
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVER CITY
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88062-0620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-574-8889
Provider Business Mailing Address Fax Number:
575-388-9151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4567 TIMMER WAY WEST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILVER CITY
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-574-8889
Provider Business Practice Location Address Fax Number:
575-388-9151
Provider Enumeration Date:
09/25/2006

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 , with the licence number:  005668 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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