MEDICARE: ELWOOD PAUL BOWERMAN LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	568	OK

General Provider Information

NPI Number	:	1255577706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELWOOD PAUL BOWERMAN LPC

Provider Business Mailing Address
First Line	:	PO BOX 95435
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73143-5435
Country	:	US
Telephone Number	:	405-620-1594
Fax Number	:

Provider Business Practice Location Address
First Line	:	8404 PINEWOOD DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-6174
Country	:	US
Telephone Number	:	405-620-1594
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2009
Last Update Date	:	01/05/2009

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