Provider Demographics
NPI:1861880213
Name:COWAN, LATASHA RESHAYE (LPC-S)
Entity type:Individual
Prefix:
First Name:LATASHA
Middle Name:RESHAYE
Last Name:COWAN
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 WEST 7TH ST. APT 504
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-3231
Mailing Address - Country:US
Mailing Address - Phone:301-310-3693
Mailing Address - Fax:
Practice Address - Street 1:2304 WEST 7TH ST. APT 504
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-3231
Practice Address - Country:US
Practice Address - Phone:301-310-3693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-07
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2029101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS2773OtherDEPTARTMENT OF MENTAL HEALTH