Provider Demographics
NPI:1871940544
Name:COWELL, JACQUELINE SIMONE (BS, QMHA)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:SIMONE
Last Name:COWELL
Suffix:
Gender:F
Credentials:BS, QMHA
Other - Prefix:MS
Other - First Name:JACKIE
Other - Middle Name:SIMONE
Other - Last Name:COWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS, QMHA
Mailing Address - Street 1:150 SHELTON MCMURPHEY BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-5015
Mailing Address - Country:US
Mailing Address - Phone:541-210-8090
Mailing Address - Fax:
Practice Address - Street 1:150 SHELTON MCMURPHEY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5015
Practice Address - Country:US
Practice Address - Phone:541-210-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health