Provider Demographics
NPI:1407025778
Name:GOWER, MAXINE ANNE
Entity Type:Individual
Prefix:
First Name:MAXINE
Middle Name:ANNE
Last Name:GOWER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2885 AURORA AVE
Mailing Address - Street 2:SUITE # 8
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-2250
Mailing Address - Country:US
Mailing Address - Phone:303-875-5046
Mailing Address - Fax:
Practice Address - Street 1:2885 AURORA AVE
Practice Address - Street 2:SUITE # 8
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2250
Practice Address - Country:US
Practice Address - Phone:303-875-5046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONCPSYP102L00000X
COCSW9922651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst