Provider Demographics
NPI:1518909910
Name:KOVACH, EDWARD ROBERT (PHD)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:ROBERT
Last Name:KOVACH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 HARPETH CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-3831
Mailing Address - Country:US
Mailing Address - Phone:931-980-0856
Mailing Address - Fax:931-358-0995
Practice Address - Street 1:130 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5064
Practice Address - Country:US
Practice Address - Phone:931-980-0856
Practice Address - Fax:931-358-0995
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2551103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist