Provider Demographics
NPI:1942697958
Name:MICHAEL J MAGOWAN LMFT PC
Entity Type:Organization
Organization Name:MICHAEL J MAGOWAN LMFT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAGOWAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:907-452-6522
Mailing Address - Street 1:PO BOX 81611
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99708-1611
Mailing Address - Country:US
Mailing Address - Phone:907-452-6522
Mailing Address - Fax:
Practice Address - Street 1:600 UNIVERSITY AVE STE 108
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3651
Practice Address - Country:US
Practice Address - Phone:907-452-6522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-17
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK309371106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty