Healthcare Provider Details

I. General information

NPI: 1447168562
Provider Name (Legal Business Name): COVINGTON CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 4TH ST
COVINGTON IN
47932-1225
US

IV. Provider business mailing address

318 4TH ST STE B
COVINGTON IN
47932-1275
US

V. Phone/Fax

Practice location:
  • Phone: 217-637-5172
  • Fax:
Mailing address:
  • Phone: 217-637-5172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JESSICA NEMECZ
Title or Position: CEO
Credential: LCPC, LMHC
Phone: 217-637-5172