MEDICARE: BENETRIA MCGOWAN LPC, SAC-IT

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	101YM0800X	Mental Health Counselor	12251125	WI
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	18981-130	WI

General Provider Information

NPI Number	:	1841831757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENETRIA MCGOWAN LPC, SAC-IT

Provider Business Mailing Address
First Line	:	7144 N 43RD ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-2221
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3026 W CONCORDIA AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-3853
Country	:	US
Telephone Number	:	414-248-6961
Fax Number	:

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

Provider Enumeration Date	:	10/01/2019
Last Update Date	:	04/06/2026

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