Provider Demographics
NPI:1538202023
Name:BOWLING, KENNETH RAY JR (IMF)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:RAY
Last Name:BOWLING
Suffix:JR
Gender:M
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68615 PEREZ ROAD
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-7200
Mailing Address - Country:US
Mailing Address - Phone:760-770-2286
Mailing Address - Fax:
Practice Address - Street 1:68615 PEREZ RD
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-7200
Practice Address - Country:US
Practice Address - Phone:760-770-2286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 76911101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health