Healthcare Provider Details

I. General information

NPI: 1134277288
Provider Name (Legal Business Name): MR. GARRY COWLES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6452 EGE O GROVE CIRCLE
ORLANDO FL
32819
US

IV. Provider business mailing address

6452 EDGE O GROVE CIR
ORLANDO FL
32819-4127
US

V. Phone/Fax

Practice location:
  • Phone: 407-493-5047
  • Fax:
Mailing address:
  • Phone: 407-493-5047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC C0568
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberTPM1815
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMBTCOU-10426
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: