Provider Demographics
NPI:1851817282
Name:MCCOWELL, KAITLYN (LMSW)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:MCCOWELL
Suffix:
Gender:F
Credentials:LMSW
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 100
Mailing Address - Street 2:
Mailing Address - City:PIERCE CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65723-2100
Mailing Address - Country:US
Mailing Address - Phone:417-476-1000
Mailing Address - Fax:417-476-1082
Practice Address - Street 1:1701 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MONETT
Practice Address - State:MO
Practice Address - Zip Code:65708-0100
Practice Address - Country:US
Practice Address - Phone:417-476-1000
Practice Address - Fax:417-236-0340
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016043586101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2016043586OtherLMSW