Provider Demographics
NPI:1063571727
Name:BOVAN, JAMES M (PSYD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:BOVAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 S LAKE PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-5964
Mailing Address - Country:US
Mailing Address - Phone:219-942-4040
Mailing Address - Fax:219-736-9131
Practice Address - Street 1:8400 LOUISIANA ST
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6385
Practice Address - Country:US
Practice Address - Phone:219-757-1924
Practice Address - Fax:219-757-1950
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042139A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical