Healthcare Provider Details

I. General information

NPI: 1003369810
Provider Name (Legal Business Name): AUDRE MOWRY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2016
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 BELLEVUE AVE STE 6A
OAKLAND CA
94610-4923
US

IV. Provider business mailing address

445 BELLEVUE AVE STE 6A
OAKLAND CA
94610-4923
US

V. Phone/Fax

Practice location:
  • Phone: 510-859-7731
  • Fax:
Mailing address:
  • Phone: 510-859-7731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMFT127251
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: