Provider Demographics
NPI:1821867581
Name:MCCOWAN, ANGEL B
Entity Type:Individual
Prefix:
First Name:ANGEL
Middle Name:B
Last Name:MCCOWAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 TEXAS ST NE APT A
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7935
Mailing Address - Country:US
Mailing Address - Phone:505-967-1652
Mailing Address - Fax:
Practice Address - Street 1:1036 TEXAS ST NE APT A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7935
Practice Address - Country:US
Practice Address - Phone:505-967-1652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician