Provider Demographics
NPI:1922369073
Name:COWDEN, KENEYSHA (LCSW)
Entity Type:Individual
Prefix:
First Name:KENEYSHA
Middle Name:
Last Name:COWDEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 JUAREZ DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76177-1200
Mailing Address - Country:US
Mailing Address - Phone:270-319-2819
Mailing Address - Fax:817-880-7117
Practice Address - Street 1:2204 JUAREZ DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-1200
Practice Address - Country:US
Practice Address - Phone:270-319-2819
Practice Address - Fax:817-880-7117
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2525061041C0700X
GACSW0068181041C0700X
TX204881106H00000X
GAMFT001700106H00000X
TX1056361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist