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General NPI Number Information
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NPI Number | 1124260948
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Entity Type | Individual
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Provider Name | BABAK GOVAN PHD
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Gender | Male
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Dates
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Enumeration Date | 03/25/2009
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Last Update Date | 05/23/2022
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Provider Practice Location Address
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Address Line | 10260 SW GREENBURG RD STE 400
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City | PORTLAND
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State | OR
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Zip | 97223-5514
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Country | US
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Telephone | 503-575-1317
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Fax | 503-388-4144
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Provider Business Mailing Address
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Address Line | 18946 TUBA ST
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City | NORTHRIDGE
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State | CA
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Zip | 91324-1230
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Country | US
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Telephone | 503-575-1317
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Fax | 503-388-4144
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY22185
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2168
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License Number State | OR
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