Provider Demographics
NPI:1447644307
Name:MCGOWEN, ROBERT JR (LPC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MCGOWEN
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:568 MAGNOLIA PKWY
Mailing Address - Street 2:
Mailing Address - City:BENBROOK
Mailing Address - State:TX
Mailing Address - Zip Code:76126-2454
Mailing Address - Country:US
Mailing Address - Phone:817-757-2740
Mailing Address - Fax:
Practice Address - Street 1:568 MAGNOLIA PKWY
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76126-2454
Practice Address - Country:US
Practice Address - Phone:817-757-2740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-27
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69308101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX343718801Medicaid
TX863LPSOtherBCBS
TX343718802Medicaid