Provider Demographics
NPI:1275989295
Name:BOWERSOX, MICHELE (LPC, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:
Last Name:BOWERSOX
Suffix:
Gender:F
Credentials:LPC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-3414
Mailing Address - Country:US
Mailing Address - Phone:315-789-2613
Mailing Address - Fax:315-789-2524
Practice Address - Street 1:111 MASON ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1459
Practice Address - Country:US
Practice Address - Phone:315-331-8493
Practice Address - Fax:315-331-6013
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006880101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health