Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 278 | OR |
N | 103G00000X | Clinical Psychologist | 278 | OR |
N | 103TC0700X | Clinical Psychologist | 278 | OR |
N | 103TF0200X | Forensic Psychologist | 278 | OR |
NPI | 1043439532 |
---|---|
Provider Name | Dr. Kevin Barry Mcgovern |
First Address | Portland, OR 97229-5485 |
Second Address | Portland, OR 97229-5485 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 08/07/2007 |