Provider Demographics
NPI:1073284295
Name:BOWMAN, MARY MARKELL (LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:MARKELL
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5690 SURFRIDER WAY UNIT 106
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-3891
Mailing Address - Country:US
Mailing Address - Phone:805-252-9254
Mailing Address - Fax:
Practice Address - Street 1:5690 SURFRIDER WAY UNIT 106
Practice Address - Street 2:
Practice Address - City:GOLETA
Practice Address - State:CA
Practice Address - Zip Code:93117-3891
Practice Address - Country:US
Practice Address - Phone:805-252-9254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT125917106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist