Provider Demographics
NPI:1881147379
Name:KOVSKI, KYLE MARC
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:MARC
Last Name:KOVSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2416 BASIL DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62707-8873
Mailing Address - Country:US
Mailing Address - Phone:217-494-9839
Mailing Address - Fax:
Practice Address - Street 1:1110 ARBOR DR
Practice Address - Street 2:SUITE A
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-9285
Practice Address - Country:US
Practice Address - Phone:217-877-9217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health