Provider Demographics
NPI:1093191165
Name:BEWLEY, MARSHALL (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:
Last Name:BEWLEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 W HICKORY ST STE 304
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4151
Mailing Address - Country:US
Mailing Address - Phone:806-535-9803
Mailing Address - Fax:
Practice Address - Street 1:207 W HICKORY ST STE 304
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4151
Practice Address - Country:US
Practice Address - Phone:940-294-6789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-30
Last Update Date:2019-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36484103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling