Provider Demographics
NPI:1831570829
Name:BOWYER, ERIC SHANE (LPC)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:SHANE
Last Name:BOWYER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9509 ASHER AVE
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-1147
Mailing Address - Country:US
Mailing Address - Phone:806-316-9999
Mailing Address - Fax:
Practice Address - Street 1:9509 ASHER AVE
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-1147
Practice Address - Country:US
Practice Address - Phone:806-316-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-15
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70280101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX47-3826906Medicaid