Healthcare Provider Details

I. General information

NPI: 1285125294
Provider Name (Legal Business Name): JUSTIN KOVANIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2018
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463 OHIO PIKE STE 102
CINCINNATI OH
45255-3746
US

IV. Provider business mailing address

463 OHIO PIKE STE 102
CINCINNATI OH
45255-3746
US

V. Phone/Fax

Practice location:
  • Phone: 513-939-0300
  • Fax:
Mailing address:
  • Phone: 513-939-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2606838
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: