Provider Demographics
NPI:1942466941
Name:MCGOWEN, PETRINA (LMFT, RDT)
Entity Type:Individual
Prefix:
First Name:PETRINA
Middle Name:
Last Name:MCGOWEN
Suffix:
Gender:F
Credentials:LMFT, RDT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3768 NE MELBA DR
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-3867
Mailing Address - Country:US
Mailing Address - Phone:772-708-2830
Mailing Address - Fax:772-237-3750
Practice Address - Street 1:672 SE MONTEREY RD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4410
Practice Address - Country:US
Practice Address - Phone:772-708-2830
Practice Address - Fax:772-237-3750
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2331106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist