Provider Demographics
NPI:1013696392
Name:VIVIANA MCGOVERN LMFT, INDIVIDUAL, MARRIAGE AND FAMILY THERAPY, INC.
Entity type:Organization
Organization Name:VIVIANA MCGOVERN LMFT, INDIVIDUAL, MARRIAGE AND FAMILY THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIVIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGOVERN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:714-485-6187
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:714-485-6187
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:714-485-6187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health