Provider Demographics
NPI:1144964123
Name:GOVAN, ALEXIS (LMHC, NPT-C)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:GOVAN
Suffix:
Gender:F
Credentials:LMHC, NPT-C
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 247
Mailing Address - Street 2:
Mailing Address - City:LA CONNER
Mailing Address - State:WA
Mailing Address - Zip Code:98257-0247
Mailing Address - Country:US
Mailing Address - Phone:360-205-5159
Mailing Address - Fax:
Practice Address - Street 1:708 E MORRIS STREET
Practice Address - Street 2:STE B
Practice Address - City:LA CONNER
Practice Address - State:WA
Practice Address - Zip Code:98257-0247
Practice Address - Country:US
Practice Address - Phone:360-205-5159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61429530101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health