Provider Demographics
NPI:1508110685
Name:MCGOVERN, PATRICK JR (LLMFT; RSST)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:MCGOVERN
Suffix:JR
Gender:M
Credentials:LLMFT; RSST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 WOODNOLL DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-4711
Mailing Address - Country:US
Mailing Address - Phone:810-249-0205
Mailing Address - Fax:
Practice Address - Street 1:1153 WOODNOLL DR
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-4711
Practice Address - Country:US
Practice Address - Phone:810-249-0205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4101006538106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist