Healthcare Provider Details

I. General information

NPI: 1073284295
Provider Name (Legal Business Name): MARY MARKELL BOWMAN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2021
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5671 EKWILL ST UNIT 103
GOLETA CA
93117-3945
US

IV. Provider business mailing address

5690 SURFRIDER WAY UNIT 106
GOLETA CA
93117-3891
US

V. Phone/Fax

Practice location:
  • Phone: 805-689-1471
  • Fax:
Mailing address:
  • Phone: 805-689-1471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT125917
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: