MEDICARE: NANNETTE BOWERS LADC-MH

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	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	1360	OK
3	101YM0800X	Mental Health Counselor	1360	OK

General Provider Information

NPI Number	:	1447604996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANNETTE BOWERS LADC-MH

Provider Business Mailing Address
First Line	:	6701 NW 8TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73127-5411
Country	:	US
Telephone Number	:	405-503-6950
Fax Number	:

Provider Business Practice Location Address
First Line	:	6701 NW 8TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73127-5411
Country	:	US
Telephone Number	:	405-503-6950
Fax Number	:

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

Provider Enumeration Date	:	04/21/2016
Last Update Date	:	11/24/2020

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