Provider Demographics
NPI:1487837753
Name:BOWEN, KIP A (LPC)
Entity Type:Individual
Prefix:MR
First Name:KIP
Middle Name:A
Last Name:BOWEN
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 1:745 CARLISLE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2415
Mailing Address - Country:US
Mailing Address - Phone:601-974-6251
Mailing Address - Fax:601-974-6260
Practice Address - Street 1:745 CARLISLE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2415
Practice Address - Country:US
Practice Address - Phone:601-974-6251
Practice Address - Fax:601-974-6260
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1105101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional