Provider Demographics
NPI:1780658047
Name:BOWEN, SUSAN (LMHC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BOWEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-5412
Mailing Address - Country:US
Mailing Address - Phone:850-522-4480
Mailing Address - Fax:850-914-9281
Practice Address - Street 1:525 E 15TH ST
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-5412
Practice Address - Country:US
Practice Address - Phone:850-522-4480
Practice Address - Fax:850-914-9281
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 7113101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health