Provider Demographics
NPI:1700411170
Name:BOWLES, BRADEN (LMSW)
Entity Type:Individual
Prefix:
First Name:BRADEN
Middle Name:
Last Name:BOWLES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 E 15TH ST STE 400A
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-5046
Mailing Address - Country:US
Mailing Address - Phone:866-397-7202
Mailing Address - Fax:
Practice Address - Street 1:1841 EXCHANGE AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108-3022
Practice Address - Country:US
Practice Address - Phone:405-602-8861
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical