MEDICARE: BOWDOIN RECOVERY SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	L000000018108	TN
2	101YP2500X	Professional Counselor	L000000018108	TN
3	106H00000X	Marriage & Family Therapist	L000000018108	TN
4	101YA0400X	Addiction (Substance Use Disorder) Counselor	L000000018108	TN
5	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073053625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOWDOIN RECOVERY SERVICES LLC

Provider Business Mailing Address
First Line	:	431 NISSAN DR STE 202
Second Line	:
City	:	SMYRNA
State	:	TN
Zip	:	37167-4365
Country	:	US
Telephone Number	:	615-462-7392
Fax Number	:	615-267-0020

Provider Business Practice Location Address
First Line	:	431 NISSAN DR STE 202
Second Line	:
City	:	SMYRNA
State	:	TN
Zip	:	37167-4365
Country	:	US
Telephone Number	:	615-462-7392
Fax Number	:	615-267-0020

Authorized Official
Title or Position	:	CONTROLLER
Name	:	LUTHER BOWDOIN
Credential	:
Telephone Number	:	615-462-7392

Provider Enumeration Date	:	03/01/2017
Last Update Date	:	08/17/2021

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Directions to “BOWDOIN RECOVERY SERVICES LLC ” Practice Location

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