Provider Demographics
NPI:1033739743
Name:COVA, JONATHAN SKY (LCPC, LAC)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:SKY
Last Name:COVA
Suffix:
Gender:M
Credentials:LCPC, LAC
Other - Prefix:MR
Other - First Name:JONATHAN
Other - Middle Name:SKY
Other - Last Name:ORNDOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7444
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59807-7444
Mailing Address - Country:US
Mailing Address - Phone:406-459-1811
Mailing Address - Fax:
Practice Address - Street 1:113 W FRONT ST STE 108
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4332
Practice Address - Country:US
Practice Address - Phone:406-213-5001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-22
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT39812101YA0400X
MT43445101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT7320234Medicaid
14688298OtherCAQH