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NPI Code Detail

MEDICARE: NICOLE RANE COWAN

MEDICARE: NICOLE RANE COWAN
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
1106H00000XMarriage & Family TherapistLMFT156232CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1390200000XOTHERCABEHAVIORAL HEALTH

General Provider Information

NPI Number : 1144764390
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE RANE COWAN
Provider Business Mailing Address
First Line : 430 N PILGRIM ST
Second Line :
City : STOCKTON
State : CA
Zip : 95205-4428
Country : US
Telephone Number : 209-466-0853
Fax Number :
Provider Business Practice Location Address
First Line : 430 N PILGRIM ST
Second Line :
City : STOCKTON
State : CA
Zip : 95205-4428
Country : US
Telephone Number : 209-466-0853
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2016
Last Update Date : 12/02/2025

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Directions to “ NICOLE RANE COWAN ” Practice Location

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