Provider Demographics
NPI:1255715983
Name:FARRAR, KOWANA BROWN (MHPS, BEHAVIOR COACH)
Entity type:Individual
Prefix:
First Name:KOWANA
Middle Name:BROWN
Last Name:FARRAR
Suffix:
Gender:
Credentials:MHPS, BEHAVIOR COACH
Other - Prefix:
Other - First Name:KOWANA
Other - Middle Name:S
Other - Last Name:FARRAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CHW
Mailing Address - Street 1:27040 E US HIGHWAY 380 APT 6107
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-1555
Mailing Address - Country:US
Mailing Address - Phone:682-558-7598
Mailing Address - Fax:855-282-5709
Practice Address - Street 1:27040 E US HIGHWAY 380 APT 6107
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-1555
Practice Address - Country:US
Practice Address - Phone:682-558-7598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171400000X
251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No171400000XOther Service ProvidersHealth & Wellness Coach
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX474501507Medicaid