Provider Demographics
NPI:1285286658
Name:COWLES, KRISTIN BORELLA (LMFT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:BORELLA
Last Name:COWLES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:BORELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:5536 COSTELLO AVE
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-5705
Mailing Address - Country:US
Mailing Address - Phone:310-430-3234
Mailing Address - Fax:
Practice Address - Street 1:5536 COSTELLO AVE
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91401-5705
Practice Address - Country:US
Practice Address - Phone:310-430-3234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT114161103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty