Provider Demographics
NPI:1346392206
Name:MCGOWIN, BRENDA MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:MARIE
Last Name:MCGOWIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:BRENDA
Other - Middle Name:MCGOWIN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1805 NW MANOR DR
Mailing Address - Street 2:
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-1754
Mailing Address - Country:US
Mailing Address - Phone:816-224-2206
Mailing Address - Fax:
Practice Address - Street 1:1007 SW WALNUT ST
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-4275
Practice Address - Country:US
Practice Address - Phone:816-229-6330
Practice Address - Fax:816-229-6332
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01886103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist