MEDICARE: PORSHA BOWEN

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	106S00000X	Behavior Technician
2	101YM0800X	Mental Health Counselor	MH26167	FL

General Provider Information

NPI Number	:	1588177687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PORSHA BOWEN

Provider Business Mailing Address
First Line	:	1864 PELICAN DR # A2
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-8042
Country	:	US
Telephone Number	:	973-727-1394
Fax Number	:

Provider Business Practice Location Address
First Line	:	1864 PELICAN DR # A2
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-8042
Country	:	US
Telephone Number	:	973-727-1394
Fax Number	:

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

Provider Enumeration Date	:	11/10/2017
Last Update Date	:	08/27/2025

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Directions to “ PORSHA BOWEN ” Practice Location

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