Provider Demographics
NPI:1346983566
Name:MOWBRAY, JOHN SPENCER (MHP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SPENCER
Last Name:MOWBRAY
Suffix:
Gender:M
Credentials:MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 WESTMORELAND DR APT 104
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-2827
Mailing Address - Country:US
Mailing Address - Phone:847-343-2180
Mailing Address - Fax:
Practice Address - Street 1:775 WESTMORELAND DR APT 104
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-2827
Practice Address - Country:US
Practice Address - Phone:847-343-2180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-15
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health