Provider Demographics
NPI:1528541844
Name:BOWEN, BRITTANY REVA (ACMHC)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:REVA
Last Name:BOWEN
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7272 S 2530 W # WET
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-3058
Mailing Address - Country:US
Mailing Address - Phone:208-479-6627
Mailing Address - Fax:
Practice Address - Street 1:7272 S 2530 W # WET
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-3058
Practice Address - Country:US
Practice Address - Phone:208-479-6627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT109461746009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health