Provider Demographics
NPI:1255577706
Name:BOWERMAN, ELWOOD PAUL (LPC)
Entity type:Individual
Prefix:
First Name:ELWOOD
Middle Name:PAUL
Last Name:BOWERMAN
Suffix:
Gender:M
Credentials:LPC
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 95435
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73143-5435
Mailing Address - Country:US
Mailing Address - Phone:405-620-1594
Mailing Address - Fax:
Practice Address - Street 1:8404 PINEWOOD DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73135-6174
Practice Address - Country:US
Practice Address - Phone:405-620-1594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-05
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK568101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional