Provider Demographics
NPI:1205176237
Name:BOWLER, DONDRANEA
Entity type:Individual
Prefix:
First Name:DONDRANEA
Middle Name:
Last Name:BOWLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 NE 53RD ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73111-6822
Mailing Address - Country:US
Mailing Address - Phone:405-816-8446
Mailing Address - Fax:
Practice Address - Street 1:11032 QUAIL CREEK RD
Practice Address - Street 2:SUITE 265
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-6219
Practice Address - Country:US
Practice Address - Phone:405-751-8640
Practice Address - Fax:405-302-2592
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-28
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor