Healthcare Provider Details

I. General information

NPI: 1518449545
Provider Name (Legal Business Name): WILLIAM BOWLER LPC, LICDC-CS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11565 PEARL RD STE 200
STRONGSVILLE OH
44136-3356
US

IV. Provider business mailing address

11565 PEARL RD STE 200
STRONGSVILLE OH
44136-3356
US

V. Phone/Fax

Practice location:
  • Phone: 440-846-0862
  • Fax: 440-846-0890
Mailing address:
  • Phone: 440-846-0862
  • Fax: 440-846-0890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC.0001894
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.78112
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: