Provider Demographics
NPI:1174789002
Name:MCGOVERN, ANDREA (MS MFT)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:MS MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28240 AGOURA RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:AGOURA
Mailing Address - State:CA
Mailing Address - Zip Code:91301-2485
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5859 DEERHEAD RD
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-3716
Practice Address - Country:US
Practice Address - Phone:310-493-4572
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 38490101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health