Provider Demographics
NPI:1124400999
Name:MCGOVERN, JULIANE LEE (LCMHC, MLADC)
Entity Type:Individual
Prefix:
First Name:JULIANE
Middle Name:LEE
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:LCMHC, MLADC
Other - Prefix:
Other - First Name:JULIANE
Other - Middle Name:
Other - Last Name:THERIAULT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2013 ELM STREET
Mailing Address - Street 2:MANNING HOUSE
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2528
Mailing Address - Country:US
Mailing Address - Phone:603-627-2702
Mailing Address - Fax:603-627-3643
Practice Address - Street 1:2013 ELM STREET
Practice Address - Street 2:MANNING HOUSE
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2528
Practice Address - Country:US
Practice Address - Phone:603-627-2702
Practice Address - Fax:603-627-3643
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1150101YA0400X
101YM0800X
NH1220101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)