MEDICARE: MOLLY DIANE MCGOWAN M.ED., LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	4471	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4471	OTHER	AL	ALABAMA BOARD OF EXAMINERS IN COUNSELING

General Provider Information

NPI Number	:	1659026375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY DIANE MCGOWAN M.ED., LPC

Provider Business Mailing Address
First Line	:	1801 2ND AVE N APT 206
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-3131
Country	:	US
Telephone Number	:	706-594-6875
Fax Number	:

Provider Business Practice Location Address
First Line	:	151 INDUSTRIAL DR
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35211-4445
Country	:	US
Telephone Number	:	205-941-1799
Fax Number	:	205-942-2037

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2022
Last Update Date	:	02/22/2022

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