Provider Demographics
NPI:1295009405
Name:BOWERS, AMY LU (LPC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LU
Last Name:BOWERS
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 1:328 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-9531
Mailing Address - Country:US
Mailing Address - Phone:304-642-1135
Mailing Address - Fax:
Practice Address - Street 1:109 WABASH AVE
Practice Address - Street 2:
Practice Address - City:PHILIPPI
Practice Address - State:WV
Practice Address - Zip Code:26416-0019
Practice Address - Country:US
Practice Address - Phone:304-457-1670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2020-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8389101YM0800X, 101YP2500X
WV2380101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6115132Medicaid