Provider Demographics
NPI:1770875916
Name:BOWMAN, MARY BETH (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY BETH
Middle Name:
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1475 FAIRGROUNDS RD
Mailing Address - Street 2:STE. 128
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2468
Mailing Address - Country:US
Mailing Address - Phone:636-724-6880
Mailing Address - Fax:636-724-6933
Practice Address - Street 1:1475 FAIRGROUNDS RD
Practice Address - Street 2:STE. 128
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2468
Practice Address - Country:US
Practice Address - Phone:636-724-6880
Practice Address - Fax:636-724-6933
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO003202104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker