Healthcare Provider Details

I. General information

NPI: 1669671301
Provider Name (Legal Business Name): BRUCE LESLIE BOWER MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 05/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W LAMBERTH RD SUITE A
SHERMAN TX
75092-2658
US

IV. Provider business mailing address

2768 N HILLBRIER CIR
PLANO TX
75075-1947
US

V. Phone/Fax

Practice location:
  • Phone: 903-892-6700
  • Fax: 903-892-6774
Mailing address:
  • Phone: 214-789-6293
  • Fax: 903-892-6774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28265
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: