MEDICARE: ELLEN CAMILLE BOWENS MFT

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
2	225C00000X	Rehabilitation Counselor

General Provider Information

NPI Number	:	1396051140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN CAMILLE BOWENS MFT

Provider Business Mailing Address
First Line	:	1481 W WARM SPRINGS RD
Second Line	:	SUITE 129
City	:	HENDERSON
State	:	NV
Zip	:	89014-7633
Country	:	US
Telephone Number	:	702-547-0201
Fax Number	:	702-944-7846

Provider Business Practice Location Address
First Line	:	1481 W WARM SPRINGS RD
Second Line	:	SUITE 129
City	:	HENDERSON
State	:	NV
Zip	:	89014-7633
Country	:	US
Telephone Number	:	702-547-0201
Fax Number	:	702-944-7846

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2010
Last Update Date	:	12/07/2010

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