Healthcare Provider Details

I. General information

NPI: 1760788822
Provider Name (Legal Business Name): MARY ELIZABETH BOWLES PSYD, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2011
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1612
POTTSBORO TX
75076-1612
US

IV. Provider business mailing address

PO BOX 1612
POTTSBORO TX
75076-1612
US

V. Phone/Fax

Practice location:
  • Phone: 970-319-1999
  • Fax:
Mailing address:
  • Phone: 970-319-1999
  • Fax: 970-945-5523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT4093
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT204129
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT.0001316
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: