MEDICARE: JOHN BOWMAN QMHA

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	101Y00000X	Counselor		NV
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1366809006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BOWMAN QMHA

Provider Business Mailing Address
First Line	:	9017 PROGRESSIVE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-3090
Country	:	US
Telephone Number	:	406-853-8544
Fax Number	:

Provider Business Practice Location Address
First Line	:	9017 PROGRESSIVE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89149-3090
Country	:	US
Telephone Number	:	406-853-8544
Fax Number	:

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

Provider Enumeration Date	:	01/26/2016
Last Update Date	:	01/26/2016

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