Provider Demographics
NPI:1235480757
Name:BOWLES, JAMEY RAY
Entity Type:Individual
Prefix:
First Name:JAMEY
Middle Name:RAY
Last Name:BOWLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 OAKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1152
Mailing Address - Country:US
Mailing Address - Phone:580-467-8376
Mailing Address - Fax:
Practice Address - Street 1:1010 OAKVIEW DR
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1152
Practice Address - Country:US
Practice Address - Phone:580-467-8376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-24
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1871717900OtherYOUTH SERVICES