Provider Demographics
NPI:1205037207
Name:JOW, WILLIAM
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:JOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:JOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3141 VIA LA SELVA
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274
Mailing Address - Country:US
Mailing Address - Phone:310-619-5793
Mailing Address - Fax:310-373-6466
Practice Address - Street 1:454 W 6TH ST
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-2632
Practice Address - Country:US
Practice Address - Phone:310-833-9300
Practice Address - Fax:310-833-9304
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 50831106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist