Provider Demographics
NPI:1144829367
Name:MOWREY, JODY (PSYD LMHC RN)
Entity type:Individual
Prefix:DR
First Name:JODY
Middle Name:
Last Name:MOWREY
Suffix:
Gender:M
Credentials:PSYD LMHC RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4206 SPANISH TRAIL PL
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8561
Mailing Address - Country:US
Mailing Address - Phone:185-086-0694
Mailing Address - Fax:
Practice Address - Street 1:9466 NAVARRE PKWY STE C
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-2948
Practice Address - Country:US
Practice Address - Phone:850-308-7292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18350101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty