Provider Demographics
NPI:1134400773
Name:BOWEN, SUSAN L (MFT INTERN)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:L
Last Name:BOWEN
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1684 HARVEST RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-5941
Mailing Address - Country:US
Mailing Address - Phone:925-336-0084
Mailing Address - Fax:
Practice Address - Street 1:6666 OWENS DR
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-3334
Practice Address - Country:US
Practice Address - Phone:925-336-0084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 62111106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist