Provider Demographics
NPI:1629570072
Name:COWLEY, JENNIFER LAINE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LAINE
Last Name:COWLEY
Suffix:
Gender:F
Credentials:LMFT
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 683
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:CA
Mailing Address - Zip Code:95938-0683
Mailing Address - Country:US
Mailing Address - Phone:530-521-5770
Mailing Address - Fax:
Practice Address - Street 1:328 B STREET
Practice Address - Street 2:#624
Practice Address - City:BIGGS
Practice Address - State:CA
Practice Address - Zip Code:95938
Practice Address - Country:US
Practice Address - Phone:530-521-5770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104808101YM0800X
CA131246106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty