Provider Demographics
NPI:1205325917
Name:BOWKER, NICOLE (LPC, NCC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:BOWKER
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7855 KITTY HAWK RD APT 1304
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-1772
Mailing Address - Country:US
Mailing Address - Phone:630-701-5154
Mailing Address - Fax:
Practice Address - Street 1:900 NE LOOP 410 STE D200
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1407
Practice Address - Country:US
Practice Address - Phone:210-822-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL17813869101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional