Provider Demographics
NPI:1710578612
Name:BOWMAN, NATHAN M (LPC)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:M
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 MARYLAND AVE APT 710
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-2314
Mailing Address - Country:US
Mailing Address - Phone:314-307-0921
Mailing Address - Fax:
Practice Address - Street 1:8500 MARYLAND AVE APT 710
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-2314
Practice Address - Country:US
Practice Address - Phone:314-307-0921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017038006101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional