Provider Demographics
NPI:1730396227
Name:BOWMAN, ELLEN RUDGE (LCPC)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:RUDGE
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 THUNDERCASTLE RD
Mailing Address - Street 2:
Mailing Address - City:READFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04355-3702
Mailing Address - Country:US
Mailing Address - Phone:207-685-9087
Mailing Address - Fax:
Practice Address - Street 1:12 SHUMAN AVE
Practice Address - Street 2:SUITE 18
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6020
Practice Address - Country:US
Practice Address - Phone:207-621-0646
Practice Address - Fax:207-621-6861
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC234101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MELICENSE # CC234OtherCLINICAL COUNSELOR