Basic Information
| Provider Information | |||||||||
| NPI: | 1487919882 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOWEN | ||||||||
| FirstName: | MYRTA | ||||||||
| MiddleName: | SUE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5410 N 44TH ST | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984073715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2537599544 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7610 40TH ST W STE 300 | ||||||||
| Address2: | |||||||||
| City: | UNIVERSITY PLACE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984663834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532786437 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2012 | ||||||||
| LastUpdateDate: | 11/30/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 175T00000X | Y |
No ID Information.