Provider Demographics
NPI:1972733392
Name:MOW, GENEVIEVE
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:MOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 S CENTINELA AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2771
Mailing Address - Country:US
Mailing Address - Phone:310-477-8558
Mailing Address - Fax:
Practice Address - Street 1:3200 MOTOR AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3710
Practice Address - Country:US
Practice Address - Phone:310-836-1223
Practice Address - Fax:310-733-2012
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64876106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist