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General NPI Number Information
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NPI Number | 1447453295
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Entity Type | Individual
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Provider Name | GLENN GOVEIA M.S.
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Gender | Male
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Dates
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Enumeration Date | 06/08/2007
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Last Update Date | 03/18/2013
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Provider Practice Location Address
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Address Line | 10649 RIVERSIDE DR
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City | TOLUCA LAKE
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State | CA
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Zip | 91602-2341
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Country | US
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Telephone | 323-692-9118
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Fax |
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Provider Business Mailing Address
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Address Line | 12326 LAUREL TERRACE DR
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City | STUDIO CITY
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State | CA
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Zip | 91604-3610
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Country | US
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Telephone | 818-769-7030
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 44939
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License Number State | CA
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