Provider Demographics
NPI:1174590046
Name:BOWEN, BILLIE RUTH (LICENSED PROFESSIONA)
Entity type:Individual
Prefix:MRS
First Name:BILLIE
Middle Name:RUTH
Last Name:BOWEN
Suffix:
Gender:F
Credentials:LICENSED PROFESSIONA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7252 PRINCEDALE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-0548
Mailing Address - Country:US
Mailing Address - Phone:903-561-3600
Mailing Address - Fax:903-565-4020
Practice Address - Street 1:7252 PRINCEDALE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-0548
Practice Address - Country:US
Practice Address - Phone:903-561-3600
Practice Address - Fax:903-565-4020
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-01
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14741101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121978406Medicaid
TX121978407Medicaid