Healthcare Provider Details

I. General information

NPI: 1336076702
Provider Name (Legal Business Name): TYLER ANTHONY BOWLES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1864 S KENTWOOD AVE
SPRINGFIELD MO
65804-2323
US

IV. Provider business mailing address

9436 LAWRENCE 2025
MILLER MO
65707-7276
US

V. Phone/Fax

Practice location:
  • Phone: 417-869-8401
  • Fax:
Mailing address:
  • Phone: 417-429-3773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2026019534
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: