Provider Demographics
NPI:1043439532
Name:MCGOVERN, KEVIN BARRY (PHD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:BARRY
Last Name:MCGOVERN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13831 NW CORNELL RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5485
Mailing Address - Country:US
Mailing Address - Phone:503-644-6600
Mailing Address - Fax:503-643-3798
Practice Address - Street 1:13831 NW CORNELL RD
Practice Address - Street 2:SUITE 103
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5485
Practice Address - Country:US
Practice Address - Phone:503-644-6600
Practice Address - Fax:503-643-3798
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR278103TB0200X, 103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic