MEDICARE: MRS. MARSHA L BOWMAN LPCC CLINICAL MENTAL

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	101YP2500X	Professional Counselor	005668	NM

General Provider Information

NPI Number	:	1720188287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARSHA L BOWMAN LPCC CLINICAL MENTAL

Provider Business Mailing Address
First Line	:	PO BOX 620
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88062-0620
Country	:	US
Telephone Number	:	575-574-8889
Fax Number	:	575-388-9151

Provider Business Practice Location Address
First Line	:	4567 TIMMER WAY WEST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061
Country	:	US
Telephone Number	:	575-574-8889
Fax Number	:	575-388-9151

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

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	09/05/2012

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