Provider Demographics
NPI:1083011993
Name:KOVATCH, MELISSA RENEE (MS, LPC)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:RENEE
Last Name:KOVATCH
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 PIKE ST FRNT
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5949
Mailing Address - Country:US
Mailing Address - Phone:610-704-0304
Mailing Address - Fax:
Practice Address - Street 1:3606 NICHOLAS ST
Practice Address - Street 2:B-3
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5100
Practice Address - Country:US
Practice Address - Phone:610-829-9201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007933101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional