Provider Demographics
NPI:1235419185
Name:BOWEN, RHONDA JO (LADC LBP)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:JO
Last Name:BOWEN
Suffix:
Gender:F
Credentials:LADC LBP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 HASLEY DR
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGE
Mailing Address - State:OK
Mailing Address - Zip Code:73120-4917
Mailing Address - Country:US
Mailing Address - Phone:405-767-3331
Mailing Address - Fax:
Practice Address - Street 1:29501 KICKAPOO RD
Practice Address - Street 2:
Practice Address - City:MCLOUD
Practice Address - State:OK
Practice Address - Zip Code:74851-8320
Practice Address - Country:US
Practice Address - Phone:405-964-1720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK530101YA0400X
OK0222101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health