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General NPI Number Information
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NPI Number | 1134446883
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Entity Type | Individual
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Provider Name | JONATHAN CLARK MCCOWN L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 04/20/2010
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Last Update Date | 04/20/2010
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Provider Practice Location Address
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Address Line | 9171 WILSHIRE BLVD PH #2
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-5530
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Country | US
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Telephone | 310-980-1365
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Fax |
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Provider Business Mailing Address
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Address Line | 320 S GRAMERCY PL 106
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City | LOS ANGELES
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State | CA
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Zip | 90020-4562
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Country | US
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Telephone | 310-980-1365
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Fax | 213-387-6134
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS21517
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License Number State | CA
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