Provider Demographics
NPI:1689168254
Name:KOVACH, HEATHER NICHOLE (BCABA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:NICHOLE
Last Name:KOVACH
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:MISS
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:MASTERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:708 BROADWATER AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-2710
Mailing Address - Country:US
Mailing Address - Phone:406-259-1680
Mailing Address - Fax:406-259-1777
Practice Address - Street 1:708 BROADWATER AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-2710
Practice Address - Country:US
Practice Address - Phone:406-259-1680
Practice Address - Fax:406-259-1777
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPSY-BA-LIC-2835103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst