Healthcare Provider Details

I. General information

NPI: 1982933990
Provider Name (Legal Business Name): COURTNEY ERIN BOWMAN LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2009
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROOSEVELT RD BLDG B 419B
GLEN ELLYN IL
60137-5839
US

IV. Provider business mailing address

475 NANTUCKET RD
NAPERVILLE IL
60565-3106
US

V. Phone/Fax

Practice location:
  • Phone: 630-935-1638
  • Fax: 630-935-1638
Mailing address:
  • Phone: 630-935-1638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180.007864
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180.007864
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: