MEDICARE: DR. TERESA MARIE COWAN-CHRISTEN PSY.D, M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	T-LP 2080	KS

General Provider Information

NPI Number	:	1104963222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERESA MARIE COWAN-CHRISTEN PSY.D, M.A.

Provider Business Mailing Address
First Line	:	1335 N ROBIN CT
Second Line	:
City	:	ANDOVER
State	:	KS
Zip	:	67002-7402
Country	:	US
Telephone Number	:	316-213-3788
Fax Number	:

Provider Business Practice Location Address
First Line	:	10333 E 21ST ST N
Second Line	:	SUITE 204
City	:	WICHITA
State	:	KS
Zip	:	67206-3543
Country	:	US
Telephone Number	:	316-630-8444
Fax Number	:	316-630-8449

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	08/04/2013

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