Provider Demographics
NPI:1104494657
Name:BOWEN, AUSTIN (LMFT, PPSC, BSP)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:BOWEN
Suffix:
Gender:
Credentials:LMFT, PPSC, BSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 ELMIRA RD. PMB # 360
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-5021
Mailing Address - Country:US
Mailing Address - Phone:530-341-3303
Mailing Address - Fax:
Practice Address - Street 1:607 ELMIRA RD. PMB # 360
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-5021
Practice Address - Country:US
Practice Address - Phone:925-323-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-11
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA127589106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health