Healthcare Provider Details

I. General information

NPI: 1720764418
Provider Name (Legal Business Name): FRANKLIN DAVID BOWEN JR. LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E MARKET ST
CELINA OH
45822-1736
US

IV. Provider business mailing address

637 S WASHINGTON ST
VAN WERT OH
45891-2307
US

V. Phone/Fax

Practice location:
  • Phone: 419-584-5123
  • Fax:
Mailing address:
  • Phone: 419-605-7043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.2304967
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: