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General NPI Number Information
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NPI Number | 1619210390
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Entity Type | Individual
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Provider Name | CRYSTAL BOWLBY PHD
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Gender | Female
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Dates
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Enumeration Date | 04/01/2013
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 6655 S YALE AVE
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City | TULSA
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State | OK
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Zip | 74136-3326
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Country | US
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Telephone | 918-491-3700
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Fax | 918-481-4063
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Provider Business Mailing Address
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Address Line | PO BOX 707001
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City | TULSA
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State | OK
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Zip | 74170-7001
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Country | US
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Telephone | 918-499-4855
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Fax | 918-488-6098
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY23856
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License Number State | CA
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