Provider Demographics
NPI:1083646673
Name:LULOW, JEFFREY M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:LULOW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16055 VENTURA BLVD
Mailing Address - Street 2:SUITE 926
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2601
Mailing Address - Country:US
Mailing Address - Phone:818-789-6689
Mailing Address - Fax:818-789-6690
Practice Address - Street 1:16055 VENTURA BLVD
Practice Address - Street 2:SUITE 926
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2611
Practice Address - Country:US
Practice Address - Phone:818-789-6689
Practice Address - Fax:818-789-6690
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 3834103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic