Provider Demographics
NPI:1063999423
Name:BOWLES, ALEXIS GELENE
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:GELENE
Last Name:BOWLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 E MINARETS AVE
Mailing Address - Street 2:
Mailing Address - City:PINEDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93650-1239
Mailing Address - Country:US
Mailing Address - Phone:559-436-0482
Mailing Address - Fax:844-587-6405
Practice Address - Street 1:380 COALINGA PLZ
Practice Address - Street 2:
Practice Address - City:COALINGA
Practice Address - State:CA
Practice Address - Zip Code:93210-1704
Practice Address - Country:US
Practice Address - Phone:885-343-1057
Practice Address - Fax:844-563-6078
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA93924101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health