Provider Demographics
NPI:1912529330
Name:MCGOWEN-PLAGA, KRISTEN ANN
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ANN
Last Name:MCGOWEN-PLAGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12729 HOMESTRETCH DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-4214
Mailing Address - Country:US
Mailing Address - Phone:817-932-3609
Mailing Address - Fax:
Practice Address - Street 1:12729 HOMESTRETCH DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-4214
Practice Address - Country:US
Practice Address - Phone:817-932-3609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72950101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health