Provider Demographics
NPI:1720282361
Name:KOVAL, JASON RONALD (LPCC)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:RONALD
Last Name:KOVAL
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:RONALD
Other - Last Name:KOVAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:6605 WEST CENTRAL AVENUE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43617-1000
Mailing Address - Country:US
Mailing Address - Phone:419-841-7701
Mailing Address - Fax:418-841-1691
Practice Address - Street 1:6605 WEST CENTRAL AVENUE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43617-1000
Practice Address - Country:US
Practice Address - Phone:419-841-7701
Practice Address - Fax:418-841-1691
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0500375101YP2500X
OHE.0500375101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional