Provider Demographics
NPI:1700936614
Name:KOVACEVICH, ELIZABETH (MFT)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:KOVACEVICH
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 EUCALYPTUS AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-6154
Mailing Address - Country:US
Mailing Address - Phone:831-425-3456
Mailing Address - Fax:
Practice Address - Street 1:627 CAPITOLA AVE STE A
Practice Address - Street 2:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2790
Practice Address - Country:US
Practice Address - Phone:831-425-3456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9137106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist