Provider Demographics
NPI:1730342254
Name:BOWLBY, SANDRA (LPC, CASAC)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:BOWLBY
Suffix:
Gender:F
Credentials:LPC, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-3442
Mailing Address - Country:US
Mailing Address - Phone:816-365-9167
Mailing Address - Fax:816-792-4845
Practice Address - Street 1:2301 BURLINGTON ST
Practice Address - Street 2:
Practice Address - City:NORTH KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64116-3015
Practice Address - Country:US
Practice Address - Phone:816-283-3396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002720101Y00000X
MO2442101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)