Healthcare Provider Details

I. General information

NPI: 1821867581
Provider Name (Legal Business Name): ANGEL B MCCOWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2023
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1036 TEXAS ST NE APT A
ALBUQUERQUE NM
87110-7935
US

IV. Provider business mailing address

1036 TEXAS ST NE APT A
ALBUQUERQUE NM
87110-7935
US

V. Phone/Fax

Practice location:
  • Phone: 505-967-1652
  • Fax:
Mailing address:
  • Phone: 505-967-1652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: