Healthcare Provider Details

I. General information

NPI: 1881139160
Provider Name (Legal Business Name): TERIKA MCGOWAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2016
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11861 COURSEY BLVD
BATON ROUGE LA
70816-4404
US

IV. Provider business mailing address

7288 TOWN SOUTH AVE APT G
BATON ROUGE LA
70808-9074
US

V. Phone/Fax

Practice location:
  • Phone: 225-612-8656
  • Fax: 225-341-8774
Mailing address:
  • Phone: 225-302-3667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: