Provider Demographics
NPI:1194859462
Name:BOWLER, JOHN M (LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:BOWLER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-4896
Mailing Address - Country:US
Mailing Address - Phone:814-723-1330
Mailing Address - Fax:814-723-5744
Practice Address - Street 1:185 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-4896
Practice Address - Country:US
Practice Address - Phone:814-723-1330
Practice Address - Fax:814-723-5744
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000692101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11657107OtherCAQH #
PA1007320880001Medicaid
PA1422136Medicare UPIN