Provider Demographics
NPI:1578746012
Name:BOWEN, LARA (MS)
Entity Type:Individual
Prefix:MRS
First Name:LARA
Middle Name:
Last Name:BOWEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11261 STRANG LINE RD
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-4040
Mailing Address - Country:US
Mailing Address - Phone:913-226-0971
Mailing Address - Fax:
Practice Address - Street 1:16308 W 127TH TER
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1388
Practice Address - Country:US
Practice Address - Phone:913-226-0971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1943101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional