Provider Demographics
NPI:1245980630
Name:BOWE, COURTNEY MICHELLE
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MICHELLE
Last Name:BOWE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:MICHELLE
Other - Last Name:BOWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:472 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-2102
Mailing Address - Country:US
Mailing Address - Phone:717-682-7418
Mailing Address - Fax:
Practice Address - Street 1:11 S STATE ST
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-2410
Practice Address - Country:US
Practice Address - Phone:717-740-6910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)