Provider Demographics
NPI:1841001435
Name:CLOW, MARY JANE (LCDC)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:JANE
Last Name:CLOW
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17206 SPRINGFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77302-7106
Mailing Address - Country:US
Mailing Address - Phone:346-560-0507
Mailing Address - Fax:
Practice Address - Street 1:4322 HERRIDGE ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77022-3945
Practice Address - Country:US
Practice Address - Phone:281-310-0956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13607101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)