Provider Demographics
NPI:1598907750
Name:KOVAC, JULIA THERESA (RN, LPC)
Entity Type:Individual
Prefix:MRS
First Name:JULIA
Middle Name:THERESA
Last Name:KOVAC
Suffix:
Gender:F
Credentials:RN, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11923 NE SHERMAN RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64156-1056
Mailing Address - Country:US
Mailing Address - Phone:816-896-6569
Mailing Address - Fax:816-781-8615
Practice Address - Street 1:11923 NE SHERMAN RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64156-1056
Practice Address - Country:US
Practice Address - Phone:816-896-6569
Practice Address - Fax:816-781-8615
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005028632101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional