Healthcare Provider Details

I. General information

NPI: 1457288763
Provider Name (Legal Business Name): REBECCA BOWMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2026
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 GRANITE DR
BARDSTOWN KY
40004-2013
US

IV. Provider business mailing address

1013 GRANITE DR
BARDSTOWN KY
40004-2013
US

V. Phone/Fax

Practice location:
  • Phone: 502-349-3100
  • Fax: 502-349-3173
Mailing address:
  • Phone: 502-349-3100
  • Fax: 502-349-3173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number296921
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: