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General NPI Number Information
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NPI Number | 1790383693
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Entity Type | Organization
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Legal Business Name | BOWLIGHT PARTNERS LLC
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Dates
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Enumeration Date | 10/13/2020
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 32 EDGEWOOD RD
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City | LEXINGTON
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State | MA
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Zip | 02420-3500
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Country | US
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Telephone | 207-712-1531
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Fax |
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Provider Business Mailing Address
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Address Line | 32 EDGEWOOD RD
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City | LEXINGTON
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State | MA
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Zip | 02420-3500
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. LOUIS B. OTT
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Credential |
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Telephone | 207-712-1531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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