Provider Demographics
NPI:1881948263
Name:COWART, CARLY (BS)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:COWART
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-8202
Mailing Address - Country:US
Mailing Address - Phone:580-332-3001
Mailing Address - Fax:
Practice Address - Street 1:704 N OAK AVE
Practice Address - Street 2:RM 20
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-3267
Practice Address - Country:US
Practice Address - Phone:580-332-3001
Practice Address - Fax:580-332-3652
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor