Provider Demographics
NPI:1679849566
Name:COWAN, DOUGLAS L (PSYD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:L
Last Name:COWAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44517 N 44TH DR
Mailing Address - Street 2:
Mailing Address - City:NEW RIVER
Mailing Address - State:AZ
Mailing Address - Zip Code:85087-6149
Mailing Address - Country:US
Mailing Address - Phone:661-972-5953
Mailing Address - Fax:
Practice Address - Street 1:44517 N 44TH DR
Practice Address - Street 2:
Practice Address - City:NEW RIVER
Practice Address - State:AZ
Practice Address - Zip Code:85087-6149
Practice Address - Country:US
Practice Address - Phone:661-972-5953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-26
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-15531106H00000X
ORT3084106H00000X
CAM24381106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALMFT-24381OtherLMFT
AZ15531OtherLMFT
ORT3084OtherLMFT