Provider Demographics
NPI:1477269439
Name:COWAN, MARISSA LORYNN (LPCA)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:LORYNN
Last Name:COWAN
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2536 DANIELLE LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-4151
Mailing Address - Country:US
Mailing Address - Phone:304-812-7728
Mailing Address - Fax:
Practice Address - Street 1:2536 DANIELLE LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-4151
Practice Address - Country:US
Practice Address - Phone:304-812-7728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY282797101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY282797OtherKENTUCKY BOARD OF LICENSED PROFESSIONAL COUNSELORS