Basic Information
| Provider Information | |||||||||
| NPI: | 1043348576 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOWMAN | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | DAVID | ||||||||
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| Credential: | MASTERS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2750 SUTTERVILLE RD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958201024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164927240 | ||||||||
| FaxNumber: | 9167361072 | ||||||||
| Practice Location | |||||||||
| Address1: | 1815 STOCKTON BLVD | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958166653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164927240 | ||||||||
| FaxNumber: | 9167361072 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2007 | ||||||||
| LastUpdateDate: | 02/29/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.