Provider Demographics
NPI:1710384136
Name:COWELL, JEFFREY (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:COWELL
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 ACADEMY DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-5301
Mailing Address - Country:US
Mailing Address - Phone:907-952-5558
Mailing Address - Fax:
Practice Address - Street 1:1805 ACADEMY DR
Practice Address - Street 2:SUITE 103
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-5301
Practice Address - Country:US
Practice Address - Phone:907-952-5558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK835101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional