Provider Demographics
NPI:1942843883
Name:BOWMAN, JACK GREGORY (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:GREGORY
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10950 COLLEGE PL
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-1506
Mailing Address - Country:US
Mailing Address - Phone:562-924-9581
Mailing Address - Fax:562-865-0168
Practice Address - Street 1:10950 COLLEGE PL
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-1506
Practice Address - Country:US
Practice Address - Phone:562-924-9581
Practice Address - Fax:562-865-0168
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42855106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist