Provider Demographics
NPI:1730767625
Name:MCGOVERN, DAVID (LLPC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MCGOVERN
Suffix:
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 SIERRA DR
Mailing Address - Street 2:
Mailing Address - City:ZEELAND
Mailing Address - State:MI
Mailing Address - Zip Code:49464-9102
Mailing Address - Country:US
Mailing Address - Phone:616-204-8278
Mailing Address - Fax:
Practice Address - Street 1:300 S STATE ST STE 13
Practice Address - Street 2:
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-1678
Practice Address - Country:US
Practice Address - Phone:616-772-1733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401019212101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor