Provider Demographics
NPI:1811757867
Name:BOWEN, TRAVIS WINSTON
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:WINSTON
Last Name:BOWEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 BASALT CT
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-3331
Mailing Address - Country:US
Mailing Address - Phone:530-917-1116
Mailing Address - Fax:
Practice Address - Street 1:3590 EL PORTAL DR APT 15
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-3154
Practice Address - Country:US
Practice Address - Phone:530-722-1114
Practice Address - Fax:530-722-1115
Is Sole Proprietor?:No
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17717101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)