Provider Demographics
NPI:1386786986
Name:KOWITCH, ARTHUR EUGENE (PHD)
Entity type:Individual
Prefix:
First Name:ARTHUR
Middle Name:EUGENE
Last Name:KOWITCH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 NE 20TH AVE
Mailing Address - Street 2:206
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2275
Mailing Address - Country:US
Mailing Address - Phone:504-234-7104
Mailing Address - Fax:503-233-7872
Practice Address - Street 1:825 NE 20TH AVE
Practice Address - Street 2:206
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2275
Practice Address - Country:US
Practice Address - Phone:504-234-7104
Practice Address - Fax:503-233-7872
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1190103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR079389Medicaid
OR079389Medicaid