Provider Demographics
NPI:1164283313
Name:MCCOU, TAWANA COVINGTON (CNLP, CHNC, CCBLC)
Entity type:Individual
Prefix:
First Name:TAWANA
Middle Name:COVINGTON
Last Name:MCCOU
Suffix:
Gender:F
Credentials:CNLP, CHNC, CCBLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 FORT MABRY LOOP
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-7199
Mailing Address - Country:US
Mailing Address - Phone:512-943-2288
Mailing Address - Fax:
Practice Address - Street 1:1530 SUN CITY BLVD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-5350
Practice Address - Country:US
Practice Address - Phone:512-943-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103TM1800X, 171400000X, 103TH0100X
174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator