Provider Demographics
NPI:1164283313
Name:COVINGTON-MCCOU, TAWANA (CNLP, CHNC, CCBLC)
Entity Type:Individual
Prefix:
First Name:TAWANA
Middle Name:
Last Name:COVINGTON-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 1:1530 SUN CITY BLVD STE 120
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-5352
Mailing Address - Country:US
Mailing Address - Phone:737-340-2255
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:737-340-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
TX171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator