MCGOVERN PSYCHOTHERAPY, LLC (NPI# 1053979435) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053979435 |
| Entity Type | Organization |
| Organization Name | MCGOVERN PSYCHOTHERAPY, LLC |
| Practice Address |
3340 Republic Ave Ste 120 St Louis Park MN 55426-4189 |
| Practice Telephone | 6125648897 |
| Enumeration Date | 2019-05-31 |
| Last Update Date | 2019-05-31 |
| Authorized Official Name | DR. AMANDA RACHEL MCGOVERN (OWNER) |
| Authorized Official Telephone | 5514865221 |
| Authorized Official Credential | PH.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities |
| Street Address |
3340 REPUBLIC AVE STE 120 |
| City | ST LOUIS PARK |
| State | MN |
| Zip Code | 55426-4189 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992130694 | Mary Colleen Morrissette | Psychologist | 3340 Republic Ave Ste 120, St Louis Park, MN 55426-4189 | 2013-09-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
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| 1912485095 | Daniel Raies | Optometrist | 8900 Minnesota 7, St Louis Park, MN 55426 | 2018-08-01 |
| 1649756040 | Wayside House, Inc. | Clinic/Center | 1349 Jersey Ave S, St. Louis Park, MN 55426 | 2018-07-18 |
| 1104302884 | Superior Caregivers, LLC | In Home Supportive Care | 1319 Lancaster Ave., St. Louis Park, MN 55426 | 2018-07-16 |
| 1396234266 | Caitlin Kwiatkowski | Behavior Technician | 7010 Mn-7, St.louis Park, MN 55426 | 2018-05-07 |
| 1497244313 | Kelly Ann Clancey | Behavior Technician | 7010 Highway 2, Saint Louis Park, MN 55426 | 2018-05-07 |
| 1770072696 | Ashleigh Hakala | Behavior Technician | 7010 Highway 7 St. Louis Park Mn 55426, St. Louis Park, MN 55426 | 2018-05-07 |
| 1689181521 | Glenda Miles | Registered Nurse | 7316 Cedar Lake Road, Apt 8, St Louis Park, MN 55426 | 2017-12-31 |
| 1174041875 | Kristen Webb | Physician Assistant | 3931 Louisiana Ave S, Suite E-500, St. Louis Park, MN 55426 | 2017-09-01 |
| 1447775549 | Belinda Sue Bliss | Marriage & Family Therapist | 3301 Decatur Lane, Saint Louis Park, MN 55426 | 2017-08-09 |
| Find all providers in zip 55426 | ||||
| Taxonomy Code | 261QM0801X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Mental Health (Including Community Mental Health Center) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992265615 | Sbtv LLC | Clinic/Center | 6121 Excelsior Blvd Ste 101a, St Louis Park, MN 55416-2752 | 2019-03-20 |
| 1881184778 | Colleen Morrissette, Pllc | Clinic/Center | 3340 Republic Ave, St Louis Park, MN 55426-4154 | 2018-05-16 |
| 1699265470 | Megan Gingo Counseling, Pllc | Clinic/Center | 3340 Republic Ave, St Louis Park, MN 55426-4154 | 2018-05-16 |
| 1225326036 | Caspersen, LLC | Clinic/Center | 5407 Excelsior Blvd, Suite B, St Louis Park, MN 55416-2929 | 2011-07-13 |
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| Find all providers with the same taxonomy | ||||
| City | ST LOUIS PARK |
| Zip Code | 55426 |
Please comment or provide details below to improve the information on MCGOVERN PSYCHOTHERAPY, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.