Provider Demographics
NPI:1104114115
Name:BOWEN, STEFFANY ANTOINETTE (CM)
Entity type:Individual
Prefix:MS
First Name:STEFFANY
Middle Name:ANTOINETTE
Last Name:BOWEN
Suffix:
Gender:F
Credentials:CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 SE 34TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73129-5107
Mailing Address - Country:US
Mailing Address - Phone:405-601-7841
Mailing Address - Fax:
Practice Address - Street 1:8901 S SANTA FE AVE
Practice Address - Street 2:SUITE E
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-8413
Practice Address - Country:US
Practice Address - Phone:405-605-5757
Practice Address - Fax:405-605-5775
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKM999635221101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health