Provider Demographics
NPI:1770660888
Name:KRAVIC, JOHN NICHOLAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:NICHOLAS
Last Name:KRAVIC
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 1:111 S SHERRIN AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-3221
Mailing Address - Country:US
Mailing Address - Phone:502-895-9999
Mailing Address - Fax:502-895-9999
Practice Address - Street 1:111 S SHERRIN AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-3221
Practice Address - Country:US
Practice Address - Phone:502-895-9999
Practice Address - Fax:502-895-9999
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0721103TC0700X, 103TC1900X, 103TC2200X, 103TF0000X, 103T00000X
KY0035106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY17608 V14833OtherALTERNATIVE HEALTH
KY7585141OtherAETNA
KY000000041691OtherBLUE CROSS BLUE SHIELD
KYKY0003291OtherTRICARE
KY044837OtherVALUE OPTIONS
KY62-52930OtherUNITED BEHAVIORAL
KY75671OtherCMG
KY17608 V14833OtherALTERNATIVE HEALTH
KY75671OtherCMG