Provider Demographics
NPI:1548477235
Name:COWAN, ANNETTE P (MFCC, CRS, RN, FAPA)
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:P
Last Name:COWAN
Suffix:
Gender:F
Credentials:MFCC, CRS, RN, FAPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11685 LORENSON RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-9111
Mailing Address - Country:US
Mailing Address - Phone:530-888-8891
Mailing Address - Fax:530-888-7899
Practice Address - Street 1:11685 LORENSON RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-9111
Practice Address - Country:US
Practice Address - Phone:530-888-8891
Practice Address - Fax:530-888-7899
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT23590106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA943223112OtherTAX ID
CA9445OtherPLACER COUNTYMANAGED CARE
CA106H00000XOtherMFT TAXONOMY CODE
CA193235RH4EPOtherNON PROFIT NUMBER