MEDICARE: MRS. JULIA THERESA KOVAC RN, LPC

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	101YP2500X	Professional Counselor	2005028632	MO

General Provider Information

NPI Number	:	1598907750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIA THERESA KOVAC RN, LPC

Provider Business Mailing Address
First Line	:	11923 NE SHERMAN RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64156-1056
Country	:	US
Telephone Number	:	816-896-6569
Fax Number	:	816-781-8615

Provider Business Practice Location Address
First Line	:	11923 NE SHERMAN RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64156-1056
Country	:	US
Telephone Number	:	816-896-6569
Fax Number	:	816-781-8615

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

Provider Enumeration Date	:	04/01/2009
Last Update Date	:	04/01/2009

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