Provider Demographics
NPI:1821743956
Name:BOWENS, RICHARD PORTER III (BA,)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:PORTER
Last Name:BOWENS
Suffix:III
Gender:M
Credentials:BA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4075 S ISABELLA RD APT DD6
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-7101
Mailing Address - Country:US
Mailing Address - Phone:313-502-9394
Mailing Address - Fax:
Practice Address - Street 1:2549 JOLLY RD STE 380
Practice Address - Street 2:
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3680
Practice Address - Country:US
Practice Address - Phone:517-300-6950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician