MEDICARE: MR. EARL LEE COWDREY MA, LPC

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	101YP2500X	Professional Counselor	6048	OK
2	101Y00000X	Counselor

General Provider Information

NPI Number	:	1225317134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EARL LEE COWDREY MA, LPC

Provider Business Mailing Address
First Line	:	12412 PARK AVE
Second Line	:
City	:	YUKON
State	:	OK
Zip	:	73099-6460
Country	:	US
Telephone Number	:	405-306-0646
Fax Number	:

Provider Business Practice Location Address
First Line	:	8516 S PENNSYLVANIA AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-5226
Country	:	US
Telephone Number	:	405-306-0646
Fax Number	:

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

Provider Enumeration Date	:	08/09/2011
Last Update Date	:	05/10/2019

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