Provider Demographics
NPI:1598746778
Name:COWART, JAMES DARRELL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:DARRELL
Last Name:COWART
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 1:308 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-4436
Mailing Address - Country:US
Mailing Address - Phone:269-344-0489
Mailing Address - Fax:
Practice Address - Street 1:5100 LOVERS LN
Practice Address - Street 2:TRESTLEWOOD, BLDG. D
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-1558
Practice Address - Country:US
Practice Address - Phone:269-342-8847
Practice Address - Fax:269-388-2346
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006209103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11274166OtherCAQHPROVIDER ID
R65940Medicare UPIN
0N58970Medicare ID - Type Unspecified