Provider Demographics
NPI:1508112707
Name:BOWMAN, MELISSA (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6700 N LINDER RD STE 156-119
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-6606
Mailing Address - Country:US
Mailing Address - Phone:208-391-3160
Mailing Address - Fax:855-745-3595
Practice Address - Street 1:6700 N LINDER RD STE 156-119
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-6606
Practice Address - Country:US
Practice Address - Phone:208-391-3160
Practice Address - Fax:855-745-3595
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMFT7109106H00000X
CAMFC 51163106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist