Healthcare Provider Details

I. General information

NPI: 1144803875
Provider Name (Legal Business Name): JENNIFER COWAN M.S. IN COUNSELING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 MAIN AVE S
TWIN FALLS ID
83301-6232
US

IV. Provider business mailing address

264 MAIN AVE S
TWIN FALLS ID
83301-6232
US

V. Phone/Fax

Practice location:
  • Phone: 208-772-4935
  • Fax: 208-734-3534
Mailing address:
  • Phone: 208-772-4935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCOUI-8117
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: