Provider Demographics
NPI:1215574603
Name:BOWMAN, MIRANDA DENISE (MSHR CRC LPC)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:DENISE
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:MSHR CRC LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3442 EDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-7897
Mailing Address - Country:US
Mailing Address - Phone:580-768-1634
Mailing Address - Fax:
Practice Address - Street 1:1300 HOPPE BLVD.,
Practice Address - Street 2:SUITE 5
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820
Practice Address - Country:US
Practice Address - Phone:580-436-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK378639101Y00000X
OK13029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor