MEDICARE: MR. JOHN ALAN BOVA LPC, LICDC, CNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	C6794	OH
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	976194	OH
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	10308	OH

General Provider Information

NPI Number	:	1366538043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN ALAN BOVA LPC, LICDC, CNP-BC

Provider Business Mailing Address
First Line	:	1175 NEWARK RD
Second Line	:
City	:	ZANESVILLE
State	:	OH
Zip	:	43701-2618
Country	:	US
Telephone Number	:	740-260-2068
Fax Number	:

Provider Business Practice Location Address
First Line	:	1175 NEWARK RD
Second Line	:
City	:	ZANESVILLE
State	:	OH
Zip	:	43701-2618
Country	:	US
Telephone Number	:	740-260-2068
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	03/05/2012

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