Provider Demographics
NPI:1427183557
Name:LACY-MCGOWAN, JANET LYNN (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:LYNN
Last Name:LACY-MCGOWAN
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:L
Other - Last Name:LACY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:15720 VENTURA BLVD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2914
Mailing Address - Country:US
Mailing Address - Phone:818-905-5292
Mailing Address - Fax:818-728-6572
Practice Address - Street 1:15720 VENTURA BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2914
Practice Address - Country:US
Practice Address - Phone:818-905-5292
Practice Address - Fax:818-728-6572
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT18979106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist