Provider Demographics
NPI:1255677829
Name:DOWELL-MARTIN, DEBRA ANN (MS)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:DOWELL-MARTIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 GLENCOE CIR
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-4828
Mailing Address - Country:US
Mailing Address - Phone:918-344-3908
Mailing Address - Fax:
Practice Address - Street 1:304 W WILL ROGERS BLVD
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-7022
Practice Address - Country:US
Practice Address - Phone:918-342-2466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-29
Last Update Date:2012-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK713101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK713OtherSTATE OF OKLAHOMA LICENSED PROFESSIONAL COUNSELOR NUMBER 713