Provider Demographics
NPI:1316547839
Name:KOVACH, AMBER (MS, LMHC, LCPC)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:KOVACH
Suffix:
Gender:F
Credentials:MS, LMHC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 W OAKLAND AVE APT 4111
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34787-1833
Mailing Address - Country:US
Mailing Address - Phone:330-974-5627
Mailing Address - Fax:
Practice Address - Street 1:701 W OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:FL
Practice Address - Zip Code:34787-1830
Practice Address - Country:US
Practice Address - Phone:330-974-5627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH22544101YM0800X, 101Y00000X
MDLC14434101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL119007100Medicaid