Basic Information
| Provider Information | |||||||||
| NPI: | 1386687226 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOWES | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMHC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 819 E. 64TH STREET, D3 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174750023 | ||||||||
| FaxNumber: | 3175683761 | ||||||||
| Practice Location | |||||||||
| Address1: | 8320 MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | INDPLS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178825122 | ||||||||
| FaxNumber: | 3178888642 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 39000115A | IN | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.