Provider Demographics
NPI:1821473810
Name:COWAN, STAR (MA)
Entity Type:Individual
Prefix:
First Name:STAR
Middle Name:
Last Name:COWAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 N MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-1481
Mailing Address - Country:US
Mailing Address - Phone:423-215-4931
Mailing Address - Fax:
Practice Address - Street 1:2125 N MAPLE AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-1481
Practice Address - Country:US
Practice Address - Phone:423-215-4931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health