=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801432547
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYNTHIA KAREN BOWMAN LPCC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2019
-----------------------------------------------------
Last Update Date | 11/18/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 240 GINGER DR
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95603-5714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-217-7117
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 474
-----------------------------------------------------
City | NEWCASTLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95658-0474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-217-7117
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LPCC6910
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------