Healthcare Provider Details

I. General information

NPI: 1043391089
Provider Name (Legal Business Name): JAMES NEIL BOW PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16836 NEWBURGH RD
LIVONIA MI
48154-1600
US

IV. Provider business mailing address

22516 BEACH ST
SAINT CLAIR SHORES MI
48081-2340
US

V. Phone/Fax

Practice location:
  • Phone: 734-464-4220
  • Fax: 734-464-5885
Mailing address:
  • Phone: 586-776-0378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301002399
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: