Provider Demographics
NPI:1639358476
Name:BROWN, DAVID BOWLES (LISW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BOWLES
Last Name:BROWN
Suffix:
Gender:M
Credentials:LISW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9717 E 42ND ST
Mailing Address - Street 2:STE 208
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74146-3618
Mailing Address - Country:US
Mailing Address - Phone:918-270-4100
Mailing Address - Fax:918-270-4101
Practice Address - Street 1:9717 E 42ND ST
Practice Address - Street 2:SUITE 208
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74146-3618
Practice Address - Country:US
Practice Address - Phone:918-270-4100
Practice Address - Fax:918-270-4101
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-78001041C0700X
OHOH1-55-09851041S0200X
OK46251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4625OtherCLINICAL SOCIAL WORKER