Provider Demographics
NPI:1154791002
Name:COWART, LAURA (MS)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:COWART
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 N 6TH ST # 5089
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-1920
Mailing Address - Country:US
Mailing Address - Phone:904-206-7372
Mailing Address - Fax:
Practice Address - Street 1:2800 N 6TH ST # 5089
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-1920
Practice Address - Country:US
Practice Address - Phone:904-206-7372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health