Provider Demographics
NPI:1366479347
Name:COWLEY, LISA CHARLEEN (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:CHARLEEN
Last Name:COWLEY
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UFP BETHESDA CLINIC
Mailing Address - Street 2:580 RICE STREET
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55103
Mailing Address - Country:US
Mailing Address - Phone:651-227-6551
Mailing Address - Fax:651-665-0684
Practice Address - Street 1:UFP BETHESDA CLINIC
Practice Address - Street 2:580 RICE STREET
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55103
Practice Address - Country:US
Practice Address - Phone:651-227-6551
Practice Address - Fax:651-665-0684
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4682103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical