Provider Demographics
NPI:1669496899
Name:GOVER, FREDRICA JILL (PHD)
Entity Type:Individual
Prefix:DR
First Name:FREDRICA
Middle Name:JILL
Last Name:GOVER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 N. VIA MIRALESTE #1618
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262
Mailing Address - Country:US
Mailing Address - Phone:760-832-9631
Mailing Address - Fax:760-832-9631
Practice Address - Street 1:611 S PALM CANYON DR
Practice Address - Street 2:SUITE 201
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-7213
Practice Address - Country:US
Practice Address - Phone:760-416-7899
Practice Address - Fax:760-416-7786
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13880103T00000X
CAPSY13880103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70034FMedicaid
CAFHC70034FMedicaid
CA051933Medicare ID - Type Unspecified