MEDICARE: RAVEN BOWMAN ALC

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	ALC04778	AL

General Provider Information

NPI Number	:	1831054717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVEN BOWMAN ALC

Provider Business Mailing Address
First Line	:	7734 MADISON BLVD STE 104
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35806-2379
Country	:	US
Telephone Number	:	931-298-9002
Fax Number	:

Provider Business Practice Location Address
First Line	:	7734 MADISON BLVD STE 104
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35806-2379
Country	:	US
Telephone Number	:	931-298-9002
Fax Number	:

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

Provider Enumeration Date	:	12/22/2025
Last Update Date	:	12/22/2025

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