Provider Demographics
NPI:1215462684
Name:BOWERS, DEREK (LMFT)
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:
Last Name:BOWERS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 ANTIETAM CT
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-3136
Mailing Address - Country:US
Mailing Address - Phone:270-304-4209
Mailing Address - Fax:
Practice Address - Street 1:3421 ANTIETAM CT
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3136
Practice Address - Country:US
Practice Address - Phone:270-304-4209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-24
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166.001719106H00000X
FLMT4686106H00000X
NC2214106H00000X
MO2023014713106H00000X
TX205324106H00000X
OHF.2300345106H00000X
KY172666106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist