Healthcare Provider Details

I. General information

NPI: 1962826974
Provider Name (Legal Business Name): WESLEY MARSHALL BOWMAN MSED, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2014
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 E STUART ST STE 2240
FORT COLLINS CO
80525-5315
US

IV. Provider business mailing address

1136 E STUART ST STE 2240
FORT COLLINS CO
80525-5315
US

V. Phone/Fax

Practice location:
  • Phone: 970-238-0268
  • Fax: 833-645-2560
Mailing address:
  • Phone: 970-238-0268
  • Fax: 833-645-2560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC.0012110
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: