Provider Demographics
NPI:1174620793
Name:JOVICK, TIMOTHY J (PHD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:JOVICK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:TIMOTHY
Other - Middle Name:J
Other - Last Name:JOVICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:8772 BIG BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-3730
Mailing Address - Country:US
Mailing Address - Phone:314-962-7788
Mailing Address - Fax:314-962-4158
Practice Address - Street 1:8772 BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-3730
Practice Address - Country:US
Practice Address - Phone:314-962-7788
Practice Address - Fax:314-962-4158
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPRY0037103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO135668OtherCOMPSYCH
MO093726OtherMAGELLAN
115260OtherBCBS
MO887579OtherFIRST HEALTH
MO077439OtherVALUE OPTIONS