Provider Demographics
NPI:1326230533
Name:COWAN, KATIE LARYN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:LARYN
Last Name:COWAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LARYN
Other - Last Name:BARCLAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 GRANITE COVE DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30642-7000
Mailing Address - Country:US
Mailing Address - Phone:404-931-6555
Mailing Address - Fax:404-393-9635
Practice Address - Street 1:951 HARMONY RD
Practice Address - Street 2:SUITE 107
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-9601
Practice Address - Country:US
Practice Address - Phone:404-931-6555
Practice Address - Fax:404-393-9635
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-11
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003177103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003106637AMedicaid
GA003106637AMedicaid