=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275201089
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCGOWAN PSYCHOLOGICAL SERVICES, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2021
-----------------------------------------------------
Last Update Date | 09/06/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 118 CASTLEWOOD DR
-----------------------------------------------------
City | CARY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27511-5510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-241-7972
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1249 KILDAIRE FARM RD STE 196
-----------------------------------------------------
City | CARY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27511-5523
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-241-7972
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PSYCHOLOGIST & OWNER
-----------------------------------------------------
Name | DR. FAITH PEREZ MCGOWAN
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 919-241-7972
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------