Healthcare Provider Details

I. General information

NPI: 1336346592
Provider Name (Legal Business Name): CHRISTIAN TOMAS BOWN LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 HERMOSA DR SE
ALBUQUERQUE NM
87108-4312
US

IV. Provider business mailing address

4910 NICHOLAS PL C
SANTA FE NM
87507-9036
US

V. Phone/Fax

Practice location:
  • Phone: 505-237-0061
  • Fax: 505-237-0068
Mailing address:
  • Phone: 219-588-0035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0103351
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0142501
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: