Basic Information
| Provider Information | |||||||||
| NPI: | 1548910300 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOVAC | ||||||||
| FirstName: | ALEXA | ||||||||
| MiddleName: | RYAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 415 55TH AVE | ||||||||
| Address2: | |||||||||
| City: | ST PETE BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337062310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273131060 | ||||||||
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| Practice Location | |||||||||
| Address1: | #436 5TH AVENUE | ||||||||
| Address2: | |||||||||
| City: | KOTZEBUE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074423321 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2022 | ||||||||
| LastUpdateDate: | 03/25/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.