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General NPI Number Information
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NPI Number | 1215574603
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Entity Type | Individual
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Provider Name | MIRANDA DENISE BOWMAN MSHR CRC NCC LPC
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Gender | Female
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Dates
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Enumeration Date | 12/04/2019
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 1013 15TH AVE. NE
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City | ARDMORE
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State | OK
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Zip | 73401
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Country | US
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Telephone | 580-238-4277
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Fax |
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Provider Business Mailing Address
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Address Line | 3442 EDGEWOOD RD
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City | ARDMORE
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State | OK
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Zip | 73401-7897
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Country | US
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Telephone | 580-768-1634
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 378639
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 13029
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License Number State | OK
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