Provider Demographics
NPI:1073101515
Name:BOWMAN-HENRY, STACY LYNN (LPC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:BOWMAN-HENRY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DEVONSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANT RIDGE
Mailing Address - State:MI
Mailing Address - Zip Code:48069-1209
Mailing Address - Country:US
Mailing Address - Phone:248-736-8490
Mailing Address - Fax:
Practice Address - Street 1:11 DEVONSHIRE RD
Practice Address - Street 2:
Practice Address - City:PLEASANT RIDGE
Practice Address - State:MI
Practice Address - Zip Code:48069-1209
Practice Address - Country:US
Practice Address - Phone:248-736-8490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI64001011353101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor