Provider Demographics
NPI:1508117755
Name:KOVACS, TIMOTHY LAWRENCE
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:LAWRENCE
Last Name:KOVACS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 1/2 S MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-5100
Mailing Address - Country:US
Mailing Address - Phone:626-319-2647
Mailing Address - Fax:
Practice Address - Street 1:503 1/2 S MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-5100
Practice Address - Country:US
Practice Address - Phone:626-319-2647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42047106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist