Provider Demographics
NPI:1447362918
Name:BOWEN, MAXWELL TARVER (MA LPC)
Entity type:Individual
Prefix:MR
First Name:MAXWELL
Middle Name:TARVER
Last Name:BOWEN
Suffix:
Gender:M
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3560 DELAWARE
Mailing Address - Street 2:STE 501
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706
Mailing Address - Country:US
Mailing Address - Phone:409-347-0554
Mailing Address - Fax:409-898-0540
Practice Address - Street 1:3560 DELAWARE
Practice Address - Street 2:STE 501
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706
Practice Address - Country:US
Practice Address - Phone:409-347-0554
Practice Address - Fax:409-898-0540
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11473101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional