MEDICARE: MR. KRYSTOFFER LOREN BOWMAN 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	101YM0800X	Mental Health Counselor	0015508	CO
2	101YP2500X	Professional Counselor	LPC.0015508	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386150738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KRYSTOFFER LOREN BOWMAN LPC

Provider Business Mailing Address
First Line	:	915 PINON RANCH VW
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-3578
Country	:	US
Telephone Number	:	719-357-7889
Fax Number	:	719-213-2484

Provider Business Practice Location Address
First Line	:	915 PINON RANCH VW
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-3578
Country	:	US
Telephone Number	:	719-357-7889
Fax Number	:	719-213-2484

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

Provider Enumeration Date	:	12/21/2017
Last Update Date	:	03/25/2024

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