Healthcare Provider Details

I. General information

NPI: 1952451668
Provider Name (Legal Business Name): TAMERA J BOWLES LCPC ATR BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 A PROFESSIONAL PARK DRIVE
MARYVILLE IL
62062-5669
US

IV. Provider business mailing address

20 PROFESSIONAL PARK DRIVE SUITE A
MARYVILLE IL
62062-5669
US

V. Phone/Fax

Practice location:
  • Phone: 618-288-8787
  • Fax: 618-288-0737
Mailing address:
  • Phone: 618-288-8787
  • Fax: 618-288-0737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: