Provider Demographics
NPI:1689104929
Name:ERIN BOWMAN, PHD, LLC
Entity Type:Organization
Organization Name:ERIN BOWMAN, PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, HSPP
Authorized Official - Phone:765-215-1736
Mailing Address - Street 1:PO BOX 283
Mailing Address - Street 2:
Mailing Address - City:MARKLE
Mailing Address - State:IN
Mailing Address - Zip Code:46770-0283
Mailing Address - Country:US
Mailing Address - Phone:765-215-1736
Mailing Address - Fax:260-206-0762
Practice Address - Street 1:9910 DUPONT CIRCLE DR E STE 140
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1618
Practice Address - Country:US
Practice Address - Phone:260-570-5414
Practice Address - Fax:260-209-0762
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-19
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042505A103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty