Healthcare Provider Details

I. General information

NPI: 1710770433
Provider Name (Legal Business Name): GREG GOVAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2025
Last Update Date: 05/26/2025
Certification Date: 05/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1534 BISHOP RD SW
TUMWATER WA
98512-7354
US

IV. Provider business mailing address

2835 CALAIS LN NW
OLYMPIA WA
98502-3931
US

V. Phone/Fax

Practice location:
  • Phone: 360-357-2370
  • Fax:
Mailing address:
  • Phone: 360-280-8522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number101YM0800X
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number103K00000X
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: