Provider Demographics
NPI:1245891985
Name:GOWER, BRYAN (MC, LPC)
Entity type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:GOWER
Suffix:
Gender:M
Credentials:MC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7055 W BELL RD STE 6
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8545
Mailing Address - Country:US
Mailing Address - Phone:602-456-4512
Mailing Address - Fax:
Practice Address - Street 1:7055 W BELL RD STE 6
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8545
Practice Address - Country:US
Practice Address - Phone:602-456-4512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-19582101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional