Provider Demographics
NPI:1417004474
Name:COWELL, DONALD RAY (PHD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:RAY
Last Name:COWELL
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:PO BOX 802003
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91380-2003
Mailing Address - Country:US
Mailing Address - Phone:661-257-4340
Mailing Address - Fax:661-257-4340
Practice Address - Street 1:25050 PEACHLAND AVE STE 255
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-5761
Practice Address - Country:US
Practice Address - Phone:661-257-4340
Practice Address - Fax:661-257-4340
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13432103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical