Basic Information
| Provider Information | |||||||||
| NPI: | 1144361478 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KATOVSICH | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MA, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 679 | ||||||||
| Address2: | |||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490850679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699852000 | ||||||||
| FaxNumber: | 2699852002 | ||||||||
| Practice Location | |||||||||
| Address1: | 903 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SAINT JOSEPH | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490851426 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2699852000 | ||||||||
| FaxNumber: | 2699852002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | 6301010974 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.