MEDICARE: DONALD RAY COWELL PH.D.

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	PSY13432	CA

General Provider Information

NPI Number	:	1417004474
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD RAY COWELL PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 802003
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91380-2003
Country	:	US
Telephone Number	:	661-257-4340
Fax Number	:	661-257-4340

Provider Business Practice Location Address
First Line	:	25050 PEACHLAND AVE STE 255
Second Line	:
City	:	NEWHALL
State	:	CA
Zip	:	91321-5761
Country	:	US
Telephone Number	:	661-257-4340
Fax Number	:	661-257-4340

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	08/27/2020

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