Provider Demographics
NPI:1811062706
Name:DOWER, MARY DAVEY (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:DAVEY
Last Name:DOWER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14777 NW MCNAMEE RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97231-2133
Mailing Address - Country:US
Mailing Address - Phone:503-621-3703
Mailing Address - Fax:503-621-3703
Practice Address - Street 1:51891 OLD PORTLAND RD
Practice Address - Street 2:SUITE B
Practice Address - City:SCAPPOOSE
Practice Address - State:OR
Practice Address - Zip Code:97056
Practice Address - Country:US
Practice Address - Phone:503-796-1116
Practice Address - Fax:503-621-3703
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2740101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health