Healthcare Provider Details

I. General information

NPI: 1235385006
Provider Name (Legal Business Name): JOHN GREG COWAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 S CARBON AVE SUITE 10
PRICE UT
84501-2852
US

IV. Provider business mailing address

23 S CARBON AVE SUITE 10
PRICE UT
84501-2852
US

V. Phone/Fax

Practice location:
  • Phone: 435-637-4852
  • Fax: 435-637-6037
Mailing address:
  • Phone: 435-637-4852
  • Fax: 435-637-6037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5982178-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: