Provider Demographics
NPI:1972066249
Name:MCGOWAN, ISABEL MARIE (LMHC)
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:MARIE
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:967 VERDINAL LN
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-1214
Mailing Address - Country:US
Mailing Address - Phone:505-469-8602
Mailing Address - Fax:
Practice Address - Street 1:5312 JAGUAR DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-1827
Practice Address - Country:US
Practice Address - Phone:505-471-4985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCSA0202531101YA0400X
NMCTB-2022-0673101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)