Basic Information
Provider Information
NPI: 1003139809
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BOWEN
FirstName: BROOKE
MiddleName: ALLISON
NamePrefix: MS.
NameSuffix:  
Credential: LPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 425 5TH AVE NW
Address2:  
City: ATTALLA
State: AL
PostalCode: 359542214
CountryCode: US
TelephoneNumber: 2564927800
FaxNumber: 2564945536
Practice Location
Address1: 301 14TH ST NW
Address2:  
City: FORT PAYNE
State: AL
PostalCode: 359673155
CountryCode: US
TelephoneNumber: 2568454571
FaxNumber: 2568454582
Other Information
ProviderEnumerationDate: 03/08/2010
LastUpdateDate: 08/13/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101Y00000X2660ALN Behavioral Health & Social Service ProvidersCounselor 
101YA0400X2660ALN Behavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
101YM0800X2660 N Behavioral Health & Social Service ProvidersCounselorMental Health
101YP2500X2660ALY Behavioral Health & Social Service ProvidersCounselorProfessional
106H00000X2660ALN Behavioral Health & Social Service ProvidersMarriage & Family Therapist 
103K00000X2660ALN Behavioral Health & Social Service ProvidersBehavioral Analyst 

No ID Information.


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