Provider Demographics
NPI:1669671301
Name:BOWER, BRUCE LESLIE (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:LESLIE
Last Name:BOWER
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2768 N HILLBRIER CIR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-1947
Mailing Address - Country:US
Mailing Address - Phone:214-789-6293
Mailing Address - Fax:903-892-6774
Practice Address - Street 1:115 W LAMBERTH RD
Practice Address - Street 2:SUITE A
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-2658
Practice Address - Country:US
Practice Address - Phone:903-892-6700
Practice Address - Fax:903-892-6774
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX282651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
613654Medicare PIN