Provider Demographics
NPI:1952451668
Name:BOWLES, TAMERA J (LCPC ATR BC)
Entity Type:Individual
Prefix:MS
First Name:TAMERA
Middle Name:J
Last Name:BOWLES
Suffix:
Gender:F
Credentials:LCPC ATR BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 PROFESSIONAL PARK DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-5669
Mailing Address - Country:US
Mailing Address - Phone:618-288-8787
Mailing Address - Fax:618-288-0737
Practice Address - Street 1:20 A PROFESSIONAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-5669
Practice Address - Country:US
Practice Address - Phone:618-288-8787
Practice Address - Fax:618-288-0737
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional