Brent L Bowen, MBA, MS, CFE, LMFT
Individual provider Active NPI Marriage & Family Therapist · Fairfax, VA
NPI 1811064090 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1811064090
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Marriage & Family Therapist 106H00000X
- License
- 0717001094 (VA)
- Practice address
- 10605 Judicial Dr
Building a-4
Fairfax, VA 22030-5167 - Phone
- (703) 273-6065
- Fax
- (703) 273-8046
- NPI assigned
- Nov 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Business Administration, Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0717001094 | VA | MD | Marriage & Family Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 0717001094 | VA | Yes |
Addresses
Primary practice location
10605 Judicial Dr
Building a-4
Fairfax, VA 22030-5167
Mailing address
10605 Judicial Dr
Building a-4
Fairfax, VA 22030-5167
Phone (703) 273-6065
Other providers in Fairfax, VA
- Kailey E Bousquet
- Martha Jean Bouveron
- Astrid Bovet
- Antoine Rashad Bowe
- Hazel E Bowen-Wright
- Nona Michelle Bowers
- Lindsay Bowling
- April Dawn Bowman
- Julie Embrey Bowman
- Moir Farrell Bowman
All providers in Fairfax, VA · Marriage & Family Therapist in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.