Provider Demographics
NPI:1861217887
Name:BOWEN, JORYN (MA, LPCC)
Entity type:Individual
Prefix:
First Name:JORYN
Middle Name:
Last Name:BOWEN
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 92
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:MN
Mailing Address - Zip Code:55731-0092
Mailing Address - Country:US
Mailing Address - Phone:218-343-4121
Mailing Address - Fax:
Practice Address - Street 1:1310 HIGHWAY 96 E STE 104C
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3618
Practice Address - Country:US
Practice Address - Phone:651-756-7590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4660101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional