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: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 2660 | AL | N | Behavioral Health & Social Service Providers | Counselor | 101YA0400X | 2660 | AL | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | 2660 | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 2660 | AL | Y | Behavioral Health & Social Service Providers | Counselor | Professional | 103K00000X | 2660 | AL | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 106H00000X | 2660 | AL | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.