Provider Demographics
NPI:1154735975
Name:COVERT, WILLIAM II (PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:COVERT
Suffix:II
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4819 S CRESTRIDGE RD
Mailing Address - Street 2:15802 STATE ROUTE 104 NORTH
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-1021
Mailing Address - Country:US
Mailing Address - Phone:614-357-2572
Mailing Address - Fax:419-537-1300
Practice Address - Street 1:15802 STATE ROUTE 104 NORTH
Practice Address - Street 2:CHILLICOTHE CORRECTIONAL INSTITUTION
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-9701
Practice Address - Country:US
Practice Address - Phone:774-740-7080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-19
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7078103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist