Provider Demographics
NPI:1730699810
Name:STOWELL, JAKE DANIEL (LMFT)
Entity type:Individual
Prefix:
First Name:JAKE
Middle Name:DANIEL
Last Name:STOWELL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 ADAMS AVE STE 214
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4865
Mailing Address - Country:US
Mailing Address - Phone:714-957-1973
Mailing Address - Fax:714-957-1922
Practice Address - Street 1:1700 ADAMS AVE STE 214
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4865
Practice Address - Country:US
Practice Address - Phone:714-957-1973
Practice Address - Fax:714-957-1922
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 390200000X
CA125971106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program