Provider Demographics
NPI:1114200318
Name:BOWLES, PAUL WOODRUFF (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:WOODRUFF
Last Name:BOWLES
Suffix:
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12830 HILLCREST RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-1527
Mailing Address - Country:US
Mailing Address - Phone:972-364-9023
Mailing Address - Fax:972-364-9095
Practice Address - Street 1:12830 HILLCREST RD
Practice Address - Street 2:SUITE 111
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-1527
Practice Address - Country:US
Practice Address - Phone:972-364-9023
Practice Address - Fax:972-364-9095
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06685101YP2500X
TX3755106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist