Healthcare Provider Details

I. General information

NPI: 1578235974
Provider Name (Legal Business Name): TARA MCGOVERN LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 SLATER RD STE 120
EAGAN MN
55122-4048
US

IV. Provider business mailing address

3629 ASHBURY RD
EAGAN MN
55122-1251
US

V. Phone/Fax

Practice location:
  • Phone: 507-481-3377
  • Fax: 612-246-3682
Mailing address:
  • Phone: 507-481-3377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPCC.0017564
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: