Basic Information
| Provider Information | |||||||||
| NPI: | 1386296739 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | IVKOVICH | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | ANTHONY | ||||||||
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| Credential: | MA, LPC, NCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 141 BRADY CIR W | ||||||||
| Address2: | |||||||||
| City: | STEUBENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439521411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402841977 | ||||||||
| FaxNumber: | 7402841978 | ||||||||
| Practice Location | |||||||||
| Address1: | 141 BRADY CIR W | ||||||||
| Address2: | |||||||||
| City: | STEUBENVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 439521411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7402841977 | ||||||||
| FaxNumber: | 7402841978 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2019 | ||||||||
| LastUpdateDate: | 02/25/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | C.1902033 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.