Provider Demographics
NPI:1225184138
Name:MOWERY, JOHN G (MA, LMFT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:G
Last Name:MOWERY
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2329
Mailing Address - Country:US
Mailing Address - Phone:303-438-9614
Mailing Address - Fax:
Practice Address - Street 1:8151 SIMMS ST
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80005-1933
Practice Address - Country:US
Practice Address - Phone:303-234-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO585106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist