=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144964123
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALEXIS GOVAN LMHC, NPT-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2022
-----------------------------------------------------
Last Update Date | 01/26/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 210 MORRIS ST APT 6
-----------------------------------------------------
City | LA CONNER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98257-7037
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-205-5159
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 247
-----------------------------------------------------
City | LA CONNER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98257-0247
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-205-5159
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | MC61429530
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------