Provider Demographics
NPI:1760711451
Name:BOWERS, NAOMI (LPC)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:BOWERS
Suffix:
Gender:F
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:PO BOX 8124
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72078-8124
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:501-420-2460
Practice Address - Street 1:108 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:AR
Practice Address - Zip Code:72042-1929
Practice Address - Country:US
Practice Address - Phone:870-946-8303
Practice Address - Fax:870-946-8217
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-09
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1306074101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR116399726Medicaid