Provider Demographics
NPI:1497922892
Name:POVLINKO, MCKENZIE A (LPCC, MFT)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:A
Last Name:POVLINKO
Suffix:
Gender:F
Credentials:LPCC, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 481
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-0481
Mailing Address - Country:US
Mailing Address - Phone:740-587-5252
Mailing Address - Fax:740-587-2571
Practice Address - Street 1:945 RIVER RD
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-9534
Practice Address - Country:US
Practice Address - Phone:740-587-5252
Practice Address - Fax:740-587-2571
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHM.0600017106H00000X
OHE.0500537-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist