Healthcare Provider Details

I. General information

NPI: 1427287754
Provider Name (Legal Business Name): MARILYN MCGOWAN LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 MEDICAL DR
MANILA AR
72442-8416
US

IV. Provider business mailing address

PO BOX 717
MANILA AR
72442-0717
US

V. Phone/Fax

Practice location:
  • Phone: 870-570-0358
  • Fax: 870-570-0359
Mailing address:
  • Phone: 870-570-0358
  • Fax: 870-570-0359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA2509005
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: