Healthcare Provider Details

I. General information

NPI: 1619426889
Provider Name (Legal Business Name): ADRIANNA R BOWYER ANDERSON ATR, LPCC, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2016
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4303 ACEQUIA LN
SANTA FE NM
87507-7155
US

IV. Provider business mailing address

3144 W BELLTOWER DR
MERIDIAN ID
83646-4882
US

V. Phone/Fax

Practice location:
  • Phone: 801-787-4608
  • Fax:
Mailing address:
  • Phone: 986-895-3122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCMH0202561
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: