MEDICARE: NAKITA BOWMAN MS, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	102L00000X	Psychoanalyst
2	103K00000X	Behavior Analyst
3	101YP2500X	Professional Counselor	79028	TX

General Provider Information

NPI Number	:	1073169876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAKITA BOWMAN MS, LPC

Provider Business Mailing Address
First Line	:	9900 WESTPARK DR STE 282
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-5285
Country	:	US
Telephone Number	:	832-953-5482
Fax Number	:

Provider Business Practice Location Address
First Line	:	9900 WESTPARK DR STE 282
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77063-5285
Country	:	US
Telephone Number	:	832-953-5482
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2019
Last Update Date	:	03/26/2021

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