Provider Demographics
NPI:1336441104
Name:COWAN, LEE (LMFT)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:
Last Name:COWAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 DOUGLAS BLVD
Mailing Address - Street 2:STE 240
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3844
Mailing Address - Country:US
Mailing Address - Phone:408-646-9755
Mailing Address - Fax:
Practice Address - Street 1:3300 DOUGLAS BLVD STE 240
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4287
Practice Address - Country:US
Practice Address - Phone:408-646-9755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-29
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85086101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)