Provider Demographics
NPI:1780153809
Name:GBOWEH, COLLETTE C
Entity type:Individual
Prefix:
First Name:COLLETTE
Middle Name:C
Last Name:GBOWEH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 68TH LN N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55430-5800
Mailing Address - Country:US
Mailing Address - Phone:612-532-3035
Mailing Address - Fax:
Practice Address - Street 1:8200 HUMBOLDT AVE S STE 100
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55431-1433
Practice Address - Country:US
Practice Address - Phone:952-236-7891
Practice Address - Fax:952-426-4935
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty