Provider Demographics
NPI:1407158603
Name:BOWDEN, WILLIAM TAFT (LCPC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:TAFT
Last Name:BOWDEN
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3939 BLACKSTONE AVE
Mailing Address - Street 2:B1
Mailing Address - City:MARKHAM
Mailing Address - State:IL
Mailing Address - Zip Code:60428-4425
Mailing Address - Country:US
Mailing Address - Phone:708-283-1631
Mailing Address - Fax:708-747-6379
Practice Address - Street 1:3939 BLACKSTONE AVE
Practice Address - Street 2:B1
Practice Address - City:MARKHAM
Practice Address - State:IL
Practice Address - Zip Code:60428-4425
Practice Address - Country:US
Practice Address - Phone:708-283-1631
Practice Address - Fax:708-747-6379
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.004084101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional