Provider Demographics
NPI:1457698771
Name:BOWLES, BRIAN (MED, PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:BOWLES
Suffix:
Gender:M
Credentials:MED, PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W NIFONG BLVD
Mailing Address - Street 2:BUILDING 1, STE 1E
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-6804
Mailing Address - Country:US
Mailing Address - Phone:573-228-6702
Mailing Address - Fax:573-228-6703
Practice Address - Street 1:601 W NIFONG BLVD
Practice Address - Street 2:BUILDING 1, STE 1E
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-6804
Practice Address - Country:US
Practice Address - Phone:573-228-6702
Practice Address - Fax:573-228-6703
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011005431101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional