| Doctor Name: | DR. JAGATHEESAN SAXON GOVENDER |
| NPI Number: | 1043579378 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D |
| License Number: | 6301012370 |
| Business Practice Address: | 42743 Alba Ct Belleville, MI - 481114818 |
| Business Phone Number: | 7346973907 |
| Business Fax Number: | |
| Mailing Address: | 3135 Professional Dr, ANN ARBOR |
| State: | MI |
| Postal Code: | 481045131 |
| Phone Number: | 7346774600 |
| Fax Number: | 7346775848 |
| NPI Enumeration Date: | 05/07/2012 |
| NPI Last Update Date: | 05/16/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 6301012370 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |