Provider Demographics
NPI:1780718148
Name:SOWELL, JENENE LOUISE
Entity type:Individual
Prefix:MRS
First Name:JENENE
Middle Name:LOUISE
Last Name:SOWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:JENENE
Other - Middle Name:LOUISE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:PO BOX 1263
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-1263
Mailing Address - Country:US
Mailing Address - Phone:530-902-3391
Mailing Address - Fax:
Practice Address - Street 1:230 MAIN ST
Practice Address - Street 2:SUITE 2-C
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2509
Practice Address - Country:US
Practice Address - Phone:530-902-3391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36345106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist