Provider Demographics
NPI:1235307018
Name:YOWELL, DAVID R (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:YOWELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-261-5159
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:2 SOUTHERN POINT PKWY STE 201
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-8025
Practice Address - Country:US
Practice Address - Phone:601-261-5159
Practice Address - Fax:601-579-5240
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS47817103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08339746Medicaid
MS08339746Medicaid