Provider Demographics
NPI:1396729174
Name:MAGOWAN, MICHAEL J (LMFT)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:MAGOWAN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:907-452-6522
Practice Address - Street 1:600 UNIVERSITY AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3643
Practice Address - Country:US
Practice Address - Phone:907-452-6522
Practice Address - Fax:907-452-6522
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK147106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist