Healthcare Provider Details

I. General information

NPI: 1366363020
Provider Name (Legal Business Name): COLIN KOVACS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 W MAIN ST STE 103
KENT OH
44240-2461
US

IV. Provider business mailing address

3774 CASCADES BLVD APT 101
KENT OH
44240-8042
US

V. Phone/Fax

Practice location:
  • Phone: 216-839-2273
  • Fax:
Mailing address:
  • Phone: 740-296-4612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: