Provider Demographics
NPI:1811172588
Name:COWAN, OLETA HALL (LCSW)
Entity type:Individual
Prefix:MS
First Name:OLETA
Middle Name:HALL
Last Name:COWAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LULU
Other - Middle Name:HALL
Other - Last Name:COWAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3229 S MILAM ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-3419
Mailing Address - Country:US
Mailing Address - Phone:806-353-0194
Mailing Address - Fax:
Practice Address - Street 1:3229 S MILAM ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-3419
Practice Address - Country:US
Practice Address - Phone:806-353-0194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical