Provider Demographics
NPI:1477074375
Name:BOWDEN, RUSSELL BRANDON (MED, LPC/TX)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:BRANDON
Last Name:BOWDEN
Suffix:
Gender:M
Credentials:MED, LPC/TX
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 N BONHAM DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-2627
Mailing Address - Country:US
Mailing Address - Phone:972-896-6018
Mailing Address - Fax:
Practice Address - Street 1:102 N BONHAM DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-2627
Practice Address - Country:US
Practice Address - Phone:972-896-6018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01483101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional