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General NPI Number Information
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NPI Number | 1639884752
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Entity Type | Individual
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Provider Name | MICHAEL E MACGOWAN PASTORAL COUNSELOR
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Gender | Male
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Dates
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Enumeration Date | 01/23/2023
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Last Update Date | 01/23/2023
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Provider Practice Location Address
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Address Line | 501 S PARK ST
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City | SAPULPA
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State | OK
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Zip | 74066-5231
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Country | US
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Telephone | 918-934-4860
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Fax |
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Provider Business Mailing Address
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Address Line | 421 W D ST
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City | JENKS
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State | OK
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Zip | 74037-2917
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Country | US
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Telephone | 910-934-4860
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | 16841
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License Number State | FL
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