Provider Demographics
NPI:1538377056
Name:KOVAL, JAMES EDWARD (PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:KOVAL
Suffix:
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:PO BOX 390
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-0390
Mailing Address - Country:US
Mailing Address - Phone:562-235-9179
Mailing Address - Fax:
Practice Address - Street 1:FAMILY AND CONSUMER SCIENCES
Practice Address - Street 2:CSULB
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90840
Practice Address - Country:US
Practice Address - Phone:562-985-7489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24507106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist