Healthcare Provider Details

I. General information

NPI: 1235334939
Provider Name (Legal Business Name): DAVID M. COWAN, PHD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 10/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43902 WOODWARD AVE SUITE 116
BLOOMFIELD HILLS MI
48302-5011
US

IV. Provider business mailing address

43902 WOODWARD AVE SUITE 116
BLOOMFIELD HILLS MI
48302-5011
US

V. Phone/Fax

Practice location:
  • Phone: 248-745-0425
  • Fax: 248-745-0536
Mailing address:
  • Phone: 248-745-0425
  • Fax: 248-745-0536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number6301005488
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301005488
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number6301005488
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number6301005488
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number6301005488
License Number StateMI
# 6
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301005488
License Number StateMI

VIII. Authorized Official

Name: DR. DAVID MICHAEL COWAN
Title or Position: OWNER
Credential: PH.D.
Phone: 248-745-0425