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General NPI Number Information
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NPI Number | 1174789002
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Entity Type | Individual
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Provider Name | ANDREA MCGOVERN MS MFT
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Gender | Female
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Dates
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Enumeration Date | 07/30/2008
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Last Update Date | 07/30/2008
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Provider Practice Location Address
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Address Line | 5859 DEERHEAD RD
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City | MALIBU
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State | CA
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Zip | 90265-3716
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Country | US
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Telephone | 310-493-4572
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Fax |
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Provider Business Mailing Address
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Address Line | 28240 AGOURA RD SUITE 304
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City | AGOURA
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State | CA
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Zip | 91301-2485
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Country | US
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Telephone |
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MFC 38490
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License Number State | CA
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