Healthcare Provider Details

I. General information

NPI: 1194908244
Provider Name (Legal Business Name): MICHAEL LOUIS HOVANCSEK M.ED. PC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 02/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 N. WATER STREET
KENT OH
44240
US

IV. Provider business mailing address

155 N. WATER STREET
KENT OH
44240
US

V. Phone/Fax

Practice location:
  • Phone: 330-678-3006
  • Fax: 330-677-7047
Mailing address:
  • Phone: 330-678-3006
  • Fax: 330-677-7047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE0500400
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE0500400
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: