MEDICARE: DR. HENRIETTA CATHERINE MCGOWAN LMHC,LPC, CAP, NCC

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	MH7983	FL

General Provider Information

NPI Number	:	1922253764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HENRIETTA CATHERINE MCGOWAN LMHC,LPC, CAP, NCC

Provider Business Mailing Address
First Line	:	405 GEORGIA AVE
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-4843
Country	:	US
Telephone Number	:	904-556-6829
Fax Number	:	202-330-4600

Provider Business Practice Location Address
First Line	:	405 GEORGIA AVE
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-4843
Country	:	US
Telephone Number	:	904-556-6829
Fax Number	:	202-330-4600

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

Provider Enumeration Date	:	11/20/2008
Last Update Date	:	11/20/2008

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