Provider Demographics
NPI:1104963222
Name:COWAN-CHRISTEN, TERESA MARIE (PSYD, MA)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:MARIE
Last Name:COWAN-CHRISTEN
Suffix:
Gender:F
Credentials:PSYD, MA
Other - Prefix:DR
Other - First Name:TERESA
Other - Middle Name:MARIE
Other - Last Name:COWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD, MA
Mailing Address - Street 1:1335 N ROBIN CT
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-7402
Mailing Address - Country:US
Mailing Address - Phone:316-213-3788
Mailing Address - Fax:
Practice Address - Street 1:10333 E 21ST ST N
Practice Address - Street 2:SUITE 204
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3543
Practice Address - Country:US
Practice Address - Phone:316-630-8444
Practice Address - Fax:316-630-8449
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2013-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-LP 2080103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical