Provider Demographics
NPI:1679005565
Name:DR. LISA BOWLES, PHD, PLLC
Entity Type:Organization
Organization Name:DR. LISA BOWLES, PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:832-579-8048
Mailing Address - Street 1:1300 BAY AREA BLVD
Mailing Address - Street 2:SUITE B275-5
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2505
Mailing Address - Country:US
Mailing Address - Phone:832-579-8048
Mailing Address - Fax:281-966-1558
Practice Address - Street 1:1300 BAY AREA BLVD
Practice Address - Street 2:SUITE B275-5
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2505
Practice Address - Country:US
Practice Address - Phone:832-579-8048
Practice Address - Fax:281-966-1558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37082103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty