=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538734215
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BETH M BOWMAN LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2021
-----------------------------------------------------
Last Update Date | 05/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 712 W 2ND ST
-----------------------------------------------------
City | ROME
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30161-2933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-237-9813
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1170 COUNTY ROAD 597
-----------------------------------------------------
City | CEDAR BLUFF
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35959-2019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-512-6340
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LPC007340
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------