Provider Demographics
NPI:1952642399
Name:BOWERS, JOHN LAWRENCE (MFT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LAWRENCE
Last Name:BOWERS
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19900 GROVE COMMUNITY DRIVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508
Mailing Address - Country:US
Mailing Address - Phone:951-571-9090
Mailing Address - Fax:
Practice Address - Street 1:19900 GROVE COMMUNITY DRIVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508
Practice Address - Country:US
Practice Address - Phone:951-571-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC51602106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist