Provider Demographics
NPI:1578235974
Name:MCGOVERN, TARA (LPCC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6122 FOURMILE CANYON DR
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-9707
Mailing Address - Country:US
Mailing Address - Phone:605-728-2006
Mailing Address - Fax:
Practice Address - Street 1:6122 FOURMILE CANYON DR
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-9707
Practice Address - Country:US
Practice Address - Phone:605-728-2006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0017564101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor