Provider Demographics
NPI:1598077620
Name:BOWLER-SHOPEYIN, THERESA DENISE (LPC)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:DENISE
Last Name:BOWLER-SHOPEYIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 N CLASSEN BLVD STE 159
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-4618
Mailing Address - Country:US
Mailing Address - Phone:405-748-6129
Mailing Address - Fax:405-607-6671
Practice Address - Street 1:4801 N CLASSEN BLVD STE 159
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-4618
Practice Address - Country:US
Practice Address - Phone:405-748-6129
Practice Address - Fax:405-607-6671
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4294101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health