Basic Information
| Provider Information | |||||||||
| NPI: | 1790817864 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOWEN | ||||||||
| FirstName: | DONNA | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.ED. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3292 LEMONHILL RD | ||||||||
| Address2: | |||||||||
| City: | CALERA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 747304507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5809246363 | ||||||||
| FaxNumber: | 5809240379 | ||||||||
| Practice Location | |||||||||
| Address1: | 3292 LEMONHILL RD | ||||||||
| Address2: | |||||||||
| City: | CALERA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 747304507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5809246363 | ||||||||
| FaxNumber: | 5809240379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 255 | OK | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.