Basic Information
| Provider Information | |||||||||
| NPI: | 1164867255 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOWAN | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | QUITMAN | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2106 LOOP RD | ||||||||
| Address2: | |||||||||
| City: | WINNSBORO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712953344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184125265 | ||||||||
| FaxNumber: | 3184353842 | ||||||||
| Practice Location | |||||||||
| Address1: | 2104 LOOP RD STE C | ||||||||
| Address2: | |||||||||
| City: | WINNSBORO | ||||||||
| State: | LA | ||||||||
| PostalCode: | 71295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3184356377 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2013 | ||||||||
| LastUpdateDate: | 03/19/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.