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NPI Code Detail

MEDICARE: DR. MISTY MARIE BOWEN LICSW, PHD

MEDICARE: DR. MISTY MARIE BOWEN LICSW, PHD
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
11041C0700XClinical Social Worker3955CAL

General Provider Information

NPI Number : 1558893446
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MISTY MARIE BOWEN LICSW, PHD
Provider Business Mailing Address
First Line : 5750A SOUTHLAND DR
Second Line :
City : MOBILE
State : AL
Zip : 36693-3316
Country : US
Telephone Number : 251-662-7303
Fax Number :
Provider Business Practice Location Address
First Line : 4211 GOVERNMENT BLVD
Second Line :
City : MOBILE
State : AL
Zip : 36693-4813
Country : US
Telephone Number : 251-662-7317
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2017
Last Update Date : 03/30/2017

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