Provider Demographics
NPI:1407315435
Name:MCGOWAN, PATTI
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:
Last Name:MCGOWAN
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 1:9718 HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-3635
Mailing Address - Country:US
Mailing Address - Phone:562-348-0250
Mailing Address - Fax:562-348-0270
Practice Address - Street 1:9718 HARVARD ST
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-3635
Practice Address - Country:US
Practice Address - Phone:562-348-0250
Practice Address - Fax:562-348-0270
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1341040319101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)