Provider Demographics
NPI:1013484716
Name:KOVALIK, JESSI KREBS (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JESSI
Middle Name:KREBS
Last Name:KOVALIK
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 SAN CLEMENTE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-4940
Mailing Address - Country:US
Mailing Address - Phone:719-351-2216
Mailing Address - Fax:
Practice Address - Street 1:703 SAN CLEMENTE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4940
Practice Address - Country:US
Practice Address - Phone:719-351-2216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO004970101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional