Provider Demographics
NPI:1134446883
Name:MCCOWN, JONATHAN CLARK (LCSW)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:CLARK
Last Name:MCCOWN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 S GRAMERCY PL
Mailing Address - Street 2:106
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-4562
Mailing Address - Country:US
Mailing Address - Phone:310-980-1365
Mailing Address - Fax:213-387-6134
Practice Address - Street 1:9171 WILSHIRE BLVD
Practice Address - Street 2:PH #2
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5530
Practice Address - Country:US
Practice Address - Phone:310-980-1365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS215171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical