Provider Demographics
NPI:1568957900
Name:BOWERS, EARLYN KELLEY (LCPC)
Entity Type:Individual
Prefix:
First Name:EARLYN
Middle Name:KELLEY
Last Name:BOWERS
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 EUSTIS PKWY
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5173
Mailing Address - Country:US
Mailing Address - Phone:207-212-6716
Mailing Address - Fax:
Practice Address - Street 1:67 EUSTIS PKWY
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5173
Practice Address - Country:US
Practice Address - Phone:207-212-6716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL4947101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health