MEDICARE: TARAN LANAE MCGOWEN MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	77026	TX

General Provider Information

NPI Number	:	1760031231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARAN LANAE MCGOWEN MA, LPC

Provider Business Mailing Address
First Line	:	1285 N MAIN ST STE 101-5
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-1511
Country	:	US
Telephone Number	:	826-517-6216
Fax Number	:	817-887-3409

Provider Business Practice Location Address
First Line	:	1285 N MAIN ST STE 101
Second Line	:
City	:	MANSFIELD
State	:	TX
Zip	:	76063-1511
Country	:	US
Telephone Number	:	682-651-7621
Fax Number	:	817-887-3409

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2019
Last Update Date	:	09/08/2019

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