Provider Demographics
NPI:1942493994
Name:GOUBANOVA, IRINA N (LPC MS)
Entity Type:Individual
Prefix:MS
First Name:IRINA
Middle Name:N
Last Name:GOUBANOVA
Suffix:
Gender:F
Credentials:LPC MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 89306
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57109
Mailing Address - Country:US
Mailing Address - Phone:605-339-1199
Mailing Address - Fax:605-335-3121
Practice Address - Street 1:1401 W 51ST ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105
Practice Address - Country:US
Practice Address - Phone:605-339-1199
Practice Address - Fax:605-335-3121
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1135101Y00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist