Provider Demographics
NPI:1144351578
Name:BOWMAN, ALEX R (EDS)
Entity type:Individual
Prefix:MR
First Name:ALEX
Middle Name:R
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1435 BUTTERMILK LN
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6909
Mailing Address - Country:US
Mailing Address - Phone:707-822-0351
Mailing Address - Fax:707-822-6589
Practice Address - Street 1:2400 BALDWIN ST
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-5168
Practice Address - Country:US
Practice Address - Phone:707-822-4858
Practice Address - Fax:707-822-6419
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool