Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 3973 | AZ |
N | 103TC0700X | Clinical Psychologist | 3973 | AZ |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 3973 | AZ |
NPI | 1033361191 |
---|---|
Provider Name | Shannon Mcgovern |
First Address | Tucson, AZ 85715-4637 |
Second Address | Tucson, AZ 85715-4637 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2008 |
Last Update Date | 23/09/2018 |