Basic Information
Provider Information
NPI: 1275050775
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MCDOWELL
FirstName: DAWN
MiddleName: RENAE
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 422 N GRIFFITH PARK DR
Address2:  
City: BURBANK
State: CA
PostalCode: 915062032
CountryCode: US
TelephoneNumber: 7604702945
FaxNumber:  
Practice Location
Address1: 1520 N RAYMOND AVE BLDG 2-7
Address2:  
City: PASADENA
State: CA
PostalCode: 911031819
CountryCode: US
TelephoneNumber: 6263965920
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/25/2017
LastUpdateDate: 02/26/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/26/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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