Provider Demographics
NPI:1720319544
Name:MCGOWEN, LINDA K (MED,PSYCHOMETRIST)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:K
Last Name:MCGOWEN
Suffix:
Gender:F
Credentials:MED,PSYCHOMETRIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43424 MCGOWEN RD
Mailing Address - Street 2:
Mailing Address - City:WISTER
Mailing Address - State:OK
Mailing Address - Zip Code:74966-2571
Mailing Address - Country:US
Mailing Address - Phone:918-658-9039
Mailing Address - Fax:
Practice Address - Street 1:43424 MCGOWEN RD
Practice Address - Street 2:
Practice Address - City:WISTER
Practice Address - State:OK
Practice Address - Zip Code:74966-2571
Practice Address - Country:US
Practice Address - Phone:918-658-9039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-18
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool