Healthcare Provider Details

I. General information

NPI: 1770026809
Provider Name (Legal Business Name): MRS. JOWANNA BELLOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 KIRKMAN ST STE C
LAKE CHARLES LA
70601-5391
US

IV. Provider business mailing address

1202 KIRKMAN ST STE C
LAKE CHARLES LA
70601-5391
US

V. Phone/Fax

Practice location:
  • Phone: 337-990-5305
  • Fax:
Mailing address:
  • Phone: 337-990-5305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPLC8726
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberPLC8726
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number8726
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: