Healthcare Provider Details

I. General information

NPI: 1841831757
Provider Name (Legal Business Name): BENETRIA Y MCGOWAN LPC, SAC-IT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3026 W CONCORDIA AVE
MILWAUKEE WI
53216-3853
US

IV. Provider business mailing address

7144 N 43RD ST
MILWAUKEE WI
53209-2221
US

V. Phone/Fax

Practice location:
  • Phone: 414-248-6961
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number12251-125
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number18981-130
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: