Healthcare Provider Details

I. General information

NPI: 1528670536
Provider Name (Legal Business Name): CAITLIN BOWLIN LP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11901 TOEPPERWEIN RD STE 1202
LIVE OAK TX
78233-3159
US

IV. Provider business mailing address

301 E MITCHELL ST
SAN ANTONIO TX
78210-3899
US

V. Phone/Fax

Practice location:
  • Phone: 517-861-1605
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number36765
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number36765
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number36765
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number36765
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number36765
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number36765
License Number StateTX
# 7
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number36765
License Number StateTX
# 8
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number36765
License Number StateTX
# 9
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number36765
License Number StateTX
# 10
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number36765
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: