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General NPI Number Information
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NPI Number | 1972890622
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Entity Type | Organization
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Legal Business Name | MELANIE BOWMAN THERAPY, LLC
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Dates
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Enumeration Date | 07/01/2011
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Last Update Date | 07/01/2011
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Provider Practice Location Address
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Address Line | 13787 BELCHER RD S SUITE 220
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City | LARGO
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State | FL
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Zip | 33771-4065
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Country | US
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Telephone | 813-748-7213
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Fax |
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Provider Business Mailing Address
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Address Line | 323 30TH AVE N
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City | SAINT PETERSBURG
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State | FL
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Zip | 33704-2948
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Country | US
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Telephone | 813-748-7213
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Fax |
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Authorized Official
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Title or Position | FOUNDER, CEO
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Name | MRS. MELANIE ERIN BOWMAN
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Credential | LCSW
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Telephone | 813-748-7213
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW10153
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License Number State | FL
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