Healthcare Provider Details

I. General information

NPI: 1174912067
Provider Name (Legal Business Name): KIM BOWMAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W BROADWAY BLDG. 3, SUITE I
COLUMBIA MO
65203-3842
US

IV. Provider business mailing address

201 W BROADWAY BLDG. 3, SUITE I
COLUMBIA MO
65203-3842
US

V. Phone/Fax

Practice location:
  • Phone: 573-214-0436
  • Fax: 573-442-0606
Mailing address:
  • Phone: 573-214-0436
  • Fax: 573-442-0606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2014029765
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: