Provider Demographics
NPI:1629362769
Name:MCGOVERN, LYNAIRE (LMFT-LICENSED MARRIA)
Entity Type:Individual
Prefix:MS
First Name:LYNAIRE
Middle Name:
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:LMFT-LICENSED MARRIA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 DALESSI DR
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2226
Mailing Address - Country:US
Mailing Address - Phone:510-451-1125
Mailing Address - Fax:
Practice Address - Street 1:5332 COLLEGE AVE
Practice Address - Street 2:# 205
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94518-2226
Practice Address - Country:US
Practice Address - Phone:510-470-0063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFTI 57794106H00000X
CA#52148106H00000X
CA52148106H00000X
CA450101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor