Provider Demographics
NPI:1700999604
Name:MCGOWAN, JEWEL E (LPC)
Entity Type:Individual
Prefix:
First Name:JEWEL
Middle Name:E
Last Name:MCGOWAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5229 W MICHIGAN AVE LOT 185
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9178
Mailing Address - Country:US
Mailing Address - Phone:734-883-4812
Mailing Address - Fax:
Practice Address - Street 1:5229 W MICHIGAN AVE LOT 185
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-9178
Practice Address - Country:US
Practice Address - Phone:734-883-4812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2012-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008396101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health