Healthcare Provider Details

I. General information

NPI: 1790556173
Provider Name (Legal Business Name): MYSHEL COWDREY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2024
Last Update Date: 01/12/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 COUGAR LN
CLOVIS CA
93611-2071
US

IV. Provider business mailing address

1800 VINE ST
LOS ANGELES CA
90028-5250
US

V. Phone/Fax

Practice location:
  • Phone: 559-835-4622
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: