Provider Demographics
NPI: | 1003396375 |
---|---|
Name: | BOWIE, WILLIAM CONNOR (LCSW) |
Entity Type: | Individual |
Prefix: | |
First Name: | WILLIAM |
Middle Name: | CONNOR |
Last Name: | BOWIE |
Suffix: | |
Gender: | M |
Credentials: | LCSW |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 7701 N LAMAR BLVD STE 314 |
Mailing Address - Street 2: | |
Mailing Address - City: | AUSTIN |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78752-1080 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 7701 N LAMAR BLVD STE 314 |
Practice Address - Street 2: | |
Practice Address - City: | AUSTIN |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78752-1080 |
Practice Address - Country: | US |
Practice Address - Phone: | 703-297-6003 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2018-08-16 |
Last Update Date: | 2024-03-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TX | 65248 | 104100000X, 1041C0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 65248 | Other | TEXAS BEHAVIORAL HEALTH EXECUTIVE COUNCIL |
65248 | Other | TEXAS BEHAVIORAL HEALTH EXECUTIVE COUNCIL |