Provider Demographics
NPI:1326744780
Name:COWANS, TREVONTAE JAMES
Entity Type:Individual
Prefix:
First Name:TREVONTAE
Middle Name:JAMES
Last Name:COWANS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6505 MARSOL RD APT 608
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44124-3511
Mailing Address - Country:US
Mailing Address - Phone:216-825-0071
Mailing Address - Fax:
Practice Address - Street 1:6505 MARSOL RD APT 608
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124-3511
Practice Address - Country:US
Practice Address - Phone:216-825-0071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator