Provider Demographics
NPI:1487822045
Name:COWAN, CONNELL O'BRIEN (PHD)
Entity type:Individual
Prefix:DR
First Name:CONNELL
Middle Name:O'BRIEN
Last Name:COWAN
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 1:15355 MULHOLLAND DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1622
Mailing Address - Country:US
Mailing Address - Phone:310-652-4760
Mailing Address - Fax:818-905-8954
Practice Address - Street 1:15355 MULHOLLAND DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90077-1622
Practice Address - Country:US
Practice Address - Phone:310-652-4760
Practice Address - Fax:818-905-8954
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 3227103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical