Healthcare Provider Details

I. General information

NPI: 1548769680
Provider Name (Legal Business Name): BOWDEN ENTERPRISE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7341 WINDY CT W
BAILEY NC
27807-8953
US

IV. Provider business mailing address

PO BOX 411
BAILEY NC
27807-0411
US

V. Phone/Fax

Practice location:
  • Phone: 857-242-1139
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number40088
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number40088
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code405300000X
TaxonomyPrevention Professional
License Number
License Number StateMN

VIII. Authorized Official

Name: TIFFANY BOWDEN
Title or Position: CEO
Credential:
Phone: 857-242-1139