Provider Demographics
NPI:1245567726
Name:MCGOWAN, MICHAEL L III (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:MCGOWAN
Suffix:III
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:PO BOX 17030
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85269-7030
Mailing Address - Country:US
Mailing Address - Phone:480-225-3236
Mailing Address - Fax:480-656-6777
Practice Address - Street 1:9375 E SHEA BLVD
Practice Address - Street 2:STE 100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6991
Practice Address - Country:US
Practice Address - Phone:480-225-3236
Practice Address - Fax:480-656-6777
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4065103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZMedicare PIN