Basic Information
| Provider Information | |||||||||
| NPI: | 1043391089 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOW | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | NEIL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22516 BEACH ST | ||||||||
| Address2: | |||||||||
| City: | SAINT CLAIR SHORES | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480812340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5867760378 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16836 NEWBURGH RD | ||||||||
| Address2: | |||||||||
| City: | LIVONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481541600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7344644220 | ||||||||
| FaxNumber: | 7344645885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 6301002399 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.