Provider Demographics
NPI:1265053870
Name:BOWLING, JAMIE LEE (BCBA)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LEE
Last Name:BOWLING
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 E PARK ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4598
Mailing Address - Country:US
Mailing Address - Phone:512-588-1362
Mailing Address - Fax:
Practice Address - Street 1:7500 RIALTO BLVD STE 250
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8531
Practice Address - Country:US
Practice Address - Phone:512-729-6224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00010774106S00000X
TX3439103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician