Provider Demographics
NPI:1326407214
Name:BOWLES, LISA D (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:D
Last Name:BOWLES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 NASA PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:SEABROOK
Mailing Address - State:TX
Mailing Address - Zip Code:77586-3445
Mailing Address - Country:US
Mailing Address - Phone:832-579-8048
Mailing Address - Fax:281-966-1558
Practice Address - Street 1:2600 NASA PKWY STE 101
Practice Address - Street 2:
Practice Address - City:SEABROOK
Practice Address - State:TX
Practice Address - Zip Code:77586-3445
Practice Address - Country:US
Practice Address - Phone:832-580-7038
Practice Address - Fax:281-966-1558
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-19
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37082103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX37082OtherLICENSE