Provider Demographics
NPI:1629179734
Name:BOWEN, ALETHEA G (MFT INTERN)
Entity Type:Individual
Prefix:MS
First Name:ALETHEA
Middle Name:G
Last Name:BOWEN
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:MISS
Other - First Name:ALETHEA
Other - Middle Name:G
Other - Last Name:SEXSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7273 14TH AVE.
Mailing Address - Street 2:120B
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-2261
Mailing Address - Country:US
Mailing Address - Phone:916-509-1857
Mailing Address - Fax:
Practice Address - Street 1:7273 14TH AVE.
Practice Address - Street 2:120B
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820-2261
Practice Address - Country:US
Practice Address - Phone:916-509-1857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 52182106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist