Provider Demographics
NPI:1376989434
Name:BOWEN, SUZETTE M (LPC)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:M
Last Name:BOWEN
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 1:8235 YMCA PLAZA DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-0939
Mailing Address - Country:US
Mailing Address - Phone:225-767-5673
Mailing Address - Fax:225-767-3501
Practice Address - Street 1:8235 YMCA PLAZA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-0939
Practice Address - Country:US
Practice Address - Phone:225-767-5673
Practice Address - Fax:225-767-3501
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3685101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA27496989OtherEIN