Provider Demographics
NPI:1609496678
Name:MCGOVERN, VIVIANA (LMFT 136563)
Entity Type:Individual
Prefix:
First Name:VIVIANA
Middle Name:
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:LMFT 136563
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20409 YORBA LINDA BLVD # 163
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3042
Mailing Address - Country:US
Mailing Address - Phone:714-485-7771
Mailing Address - Fax:
Practice Address - Street 1:21520 YORBA LINDA BLVD STE G
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92887-3764
Practice Address - Country:US
Practice Address - Phone:714-485-7771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-20
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA136563106H00000X
CALMFT136563101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist