Provider Demographics
NPI:1033484316
Name:BOWEN, KATRINA MARIE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:MARIE
Last Name:BOWEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:KATRINA
Other - Middle Name:MARIE
Other - Last Name:ARNOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLPC
Mailing Address - Street 1:2888 E LONG LAKE RD STE 130
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-3793
Mailing Address - Country:US
Mailing Address - Phone:248-494-1452
Mailing Address - Fax:
Practice Address - Street 1:2888 E LONG LAKE RD STE 130
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-3793
Practice Address - Country:US
Practice Address - Phone:248-494-1452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012879101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor