Healthcare Provider Details

I. General information

NPI: 1629159025
Provider Name (Legal Business Name): WILLIAM A COWLES LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

688 BRENTWOOD DR
PALISADE CO
81526
US

IV. Provider business mailing address

688 BRENTWOOD DR
PALISADE CO
81526
US

V. Phone/Fax

Practice location:
  • Phone: 970-464-7348
  • Fax: 970-464-7348
Mailing address:
  • Phone: 970-464-7348
  • Fax: 970-464-7348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number982004
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: