Provider Demographics
NPI:1497783476
Name:BOWLES, MARK ELLEN (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:MARK
Middle Name:ELLEN
Last Name:BOWLES
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E STATE LOOP 543
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:TX
Mailing Address - Zip Code:78963-5267
Mailing Address - Country:US
Mailing Address - Phone:512-289-5623
Mailing Address - Fax:
Practice Address - Street 1:502 HILL ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3949
Practice Address - Country:US
Practice Address - Phone:512-289-5623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13539101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1219446 05Medicaid