Provider Demographics
NPI:1033294046
Name:GOWEN, JULIE B (LCSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:B
Last Name:GOWEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10106 LORENE LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-4407
Mailing Address - Country:US
Mailing Address - Phone:210-219-4991
Mailing Address - Fax:210-399-0751
Practice Address - Street 1:16607 BLANCO RD
Practice Address - Street 2:STE 904
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1913
Practice Address - Country:US
Practice Address - Phone:210-219-4991
Practice Address - Fax:210-399-0751
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX26712104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00239691Medicare PIN
TX8D6807Medicare ID - Type Unspecified
TXP00239691Medicare PIN