Provider Demographics
NPI:1154193472
Name:GOVAN, TYE'E R
Entity type:Individual
Prefix:
First Name:TYE'E
Middle Name:R
Last Name:GOVAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1352 W 29TH ST
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33404-3524
Mailing Address - Country:US
Mailing Address - Phone:561-848-0582
Mailing Address - Fax:
Practice Address - Street 1:12300 ALT A1A STE 114-116
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2205
Practice Address - Country:US
Practice Address - Phone:561-284-6680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician