Healthcare Provider Details

I. General information

NPI: 1972066249
Provider Name (Legal Business Name): ISABEL MARIE MCGOWAN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 11/29/2022
Certification Date: 11/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5312 JAGUAR DR
SANTA FE NM
87507-1827
US

IV. Provider business mailing address

967 VERDINAL LN
SANTA FE NM
87505-1214
US

V. Phone/Fax

Practice location:
  • Phone: 505-471-4985
  • Fax:
Mailing address:
  • Phone: 505-469-8602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCSA0202531
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2022-0673
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: