Provider Demographics
NPI:1194080770
Name:DOW, COLIN (MA MFT)
Entity type:Individual
Prefix:MR
First Name:COLIN
Middle Name:
Last Name:DOW
Suffix:
Gender:M
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9093 ELK GROVE BLVD
Mailing Address - Street 2:205
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2047
Mailing Address - Country:US
Mailing Address - Phone:916-628-9045
Mailing Address - Fax:
Practice Address - Street 1:9093 ELK GROVE BLVD
Practice Address - Street 2:205
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2047
Practice Address - Country:US
Practice Address - Phone:916-628-9045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 39730106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist