MEDICARE: LESLIE A MCGOVERN MA

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	LMH 00005154	WA

General Provider Information

NPI Number	:	1740726413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE A MCGOVERN MA

Provider Business Mailing Address
First Line	:	9740 46TH AVE NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-2620
Country	:	US
Telephone Number	:	206-915-2741
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 NE 41ST ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-5428
Country	:	US
Telephone Number	:	206-915-2741
Fax Number	:

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

Provider Enumeration Date	:	01/18/2017
Last Update Date	:	01/18/2017

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Directions to “ LESLIE A MCGOVERN MA” Practice Location

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