Provider Demographics
NPI:1457817991
Name:MCGOWAN, RAVEN ANTIONETTE
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:ANTIONETTE
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 1:5110 GRIGGS RD APT 1350
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-3236
Mailing Address - Country:US
Mailing Address - Phone:281-908-4338
Mailing Address - Fax:
Practice Address - Street 1:5110 GRIGGS RD APT 1350
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-3236
Practice Address - Country:US
Practice Address - Phone:281-908-4338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician