Healthcare Provider Details

I. General information

NPI: 1366356560
Provider Name (Legal Business Name): CIVILITY HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N LAKE SHORE DR STE 110-1237
CHICAGO IL
60611-4546
US

IV. Provider business mailing address

680 N LAKE SHORE DR STE 110-1237
CHICAGO IL
60611-4546
US

V. Phone/Fax

Practice location:
  • Phone: 312-437-0945
  • Fax:
Mailing address:
  • Phone: 312-437-0945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: DAVID BRIAN KOVACH JR.
Title or Position: OWNER
Credential: LCPC
Phone: 312-869-4009