Provider Demographics
NPI:1275042582
Name:GOVIN, MYREL MARIA I (BACHELOR'S DEGREE)
Entity Type:Individual
Prefix:
First Name:MYREL
Middle Name:MARIA
Last Name:GOVIN
Suffix:I
Gender:F
Credentials:BACHELOR'S DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5665 W 20TH AVE APT 312
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7532
Mailing Address - Country:US
Mailing Address - Phone:786-310-8939
Mailing Address - Fax:
Practice Address - Street 1:5665 W 20TH AVE APT 312
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7532
Practice Address - Country:US
Practice Address - Phone:786-310-8939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician