Provider Demographics
NPI:1568670404
Name:BOWMAN, CHARLES E (MS, LCSW, LMFT)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:E
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:MS, LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9292 N MERIDIAN ST STE 311
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1828
Mailing Address - Country:US
Mailing Address - Phone:317-843-0717
Mailing Address - Fax:
Practice Address - Street 1:9292 N MERIDIAN ST STE 311
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1828
Practice Address - Country:US
Practice Address - Phone:317-843-0717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002755A1041C0700X
IN35000195A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist