Healthcare Provider Details

I. General information

NPI: 1063999423
Provider Name (Legal Business Name): ALEXIS GELENE BOWLES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 COALINGA PLZ
COALINGA CA
93210-1704
US

IV. Provider business mailing address

40 E MINARETS AVE
PINEDALE CA
93650-1239
US

V. Phone/Fax

Practice location:
  • Phone: 885-343-1057
  • Fax: 844-563-6078
Mailing address:
  • Phone: 559-436-0482
  • Fax: 844-587-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number93924
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: