Provider Demographics
NPI:1124704655
Name:MCGOWEN, NICOLE GABRIELLE (LPC)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:GABRIELLE
Last Name:MCGOWEN
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 1:3401 CORDONE ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76133-1430
Mailing Address - Country:US
Mailing Address - Phone:817-360-3058
Mailing Address - Fax:
Practice Address - Street 1:3401 CORDONE ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76133-1430
Practice Address - Country:US
Practice Address - Phone:817-360-3058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80409101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional