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General NPI Number Information
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NPI Number | 1114304615
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Entity Type | Individual
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Provider Name | AUSTIN HENRY KOVAR MA, TLLP
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Gender | Male
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Dates
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Enumeration Date | 05/04/2015
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Last Update Date | 08/13/2015
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Provider Practice Location Address
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Address Line | 35640 W MICHIGAN AVE
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City | WAYNE
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State | MI
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Zip | 48184-1628
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Country | US
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Telephone | 734-729-7792
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Fax |
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Provider Business Mailing Address
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Address Line | 25857 SPRINGBROOK DR
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City | FARMINGTON HILLS
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State | MI
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Zip | 48336-1377
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Country | US
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Telephone | 248-320-6750
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6301016418
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License Number State | MI
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