Provider Demographics
NPI:1689695173
Name:BOWLES, DEREK THOMAS (LCSW, MSW)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:THOMAS
Last Name:BOWLES
Suffix:
Gender:M
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 689
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-0689
Mailing Address - Country:US
Mailing Address - Phone:801-451-7799
Mailing Address - Fax:801-451-6331
Practice Address - Street 1:291 S 200 W
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2419
Practice Address - Country:US
Practice Address - Phone:801-451-7799
Practice Address - Fax:801-451-6331
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4950278-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical