Provider Demographics
NPI:1396320586
Name:MCGOVERN, JODIE (LPC)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 287
Mailing Address - Street 2:
Mailing Address - City:SOUTH HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15081-0287
Mailing Address - Country:US
Mailing Address - Phone:724-495-9689
Mailing Address - Fax:
Practice Address - Street 1:1010 BRODHEAD RD
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-2322
Practice Address - Country:US
Practice Address - Phone:412-339-1782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013065101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional