Provider Demographics
NPI:1104046655
Name:MCGOVERN, JOHN EDWARD (LCSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EDWARD
Last Name:MCGOVERN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 361
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80437-0361
Mailing Address - Country:US
Mailing Address - Phone:303-754-7727
Mailing Address - Fax:303-674-2090
Practice Address - Street 1:5460 WARD RD
Practice Address - Street 2:SUITE 125
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-1825
Practice Address - Country:US
Practice Address - Phone:303-754-7727
Practice Address - Fax:303-674-2090
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9911031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical