Basic Information
| Provider Information | |||||||||
| NPI: | 1063999423 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BOWLES | ||||||||
| FirstName: | ALEXIS | ||||||||
| MiddleName: | GELENE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 E MINARETS AVE | ||||||||
| Address2: | |||||||||
| City: | PINEDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 936501239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594360482 | ||||||||
| FaxNumber: | 8445876405 | ||||||||
| Practice Location | |||||||||
| Address1: | 380 COALINGA PLZ | ||||||||
| Address2: | |||||||||
| City: | COALINGA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932101704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8853431057 | ||||||||
| FaxNumber: | 8445636078 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2018 | ||||||||
| LastUpdateDate: | 01/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 93924 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.