Provider Demographics
NPI:1336387737
Name:BILLIE BOWEN COUNSELING
Entity Type:Organization
Organization Name:BILLIE BOWEN COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BILLIE
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:903-561-3600
Mailing Address - Street 1:3605 WOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75707-1663
Mailing Address - Country:US
Mailing Address - Phone:903-561-3600
Mailing Address - Fax:903-363-9043
Practice Address - Street 1:2010 SYBIL LN STE 106
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1821
Practice Address - Country:US
Practice Address - Phone:903-561-3600
Practice Address - Fax:903-363-9043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14741101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121978406Medicaid