MEDICARE: MR. ROYCE ALAN BOWLIN QMHP, M.S. PSY

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

General Provider Information

NPI Number	:	1891888475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROYCE ALAN BOWLIN QMHP, M.S. PSY

Provider Business Mailing Address
First Line	:	PO BOX 8459
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97207-8459
Country	:	US
Telephone Number	:	503-750-4978
Fax Number	:

Provider Business Practice Location Address
First Line	:	3034 NE MLK
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-3053
Country	:	US
Telephone Number	:	503-750-4978
Fax Number	:

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

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	04/10/2008

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