Provider Demographics
NPI:1083306476
Name:ROWAN, CARLY MELISSA
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:MELISSA
Last Name:ROWAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 W HAWKINS PKWY APT 4301
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-1728
Mailing Address - Country:US
Mailing Address - Phone:909-635-8404
Mailing Address - Fax:
Practice Address - Street 1:411 W HAWKINS PKWY APT 4301
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-1728
Practice Address - Country:US
Practice Address - Phone:909-635-8404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health