Provider Demographics
NPI:1689698532
Name:BOWEN, ANGIE GALLER (LCSW,CCBT,CRH)
Entity Type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:GALLER
Last Name:BOWEN
Suffix:
Gender:F
Credentials:LCSW,CCBT,CRH
Other - Prefix:MRS
Other - First Name:ANGIE
Other - Middle Name:GALLER
Other - Last Name:VAUGHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW,CCBT,CRH
Mailing Address - Street 1:448 N CEDAR BLUFF RD # 214
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-3612
Mailing Address - Country:US
Mailing Address - Phone:865-679-6379
Mailing Address - Fax:865-694-6138
Practice Address - Street 1:244 N PETERS RD
Practice Address - Street 2:SUITE 221
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4933
Practice Address - Country:US
Practice Address - Phone:865-679-6379
Practice Address - Fax:865-694-6138
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3922860Medicaid
TN3922860Medicaid