Provider Demographics
NPI:1558777839
Name:MOWRY, DAVE
Entity Type:Individual
Prefix:
First Name:DAVE
Middle Name:
Last Name:MOWRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13913 SE HAMPSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-1650
Mailing Address - Country:US
Mailing Address - Phone:503-577-3904
Mailing Address - Fax:
Practice Address - Street 1:13913 SE HAMPSHIRE CT
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-1650
Practice Address - Country:US
Practice Address - Phone:503-577-3904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health