1821218264 NPI number — MRS. DOREE ERIKA KOVIS-TONKS LCSW

Table of content: MRS. DOREE ERIKA KOVIS-TONKS LCSW (NPI 1821218264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821218264 NPI number — MRS. DOREE ERIKA KOVIS-TONKS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOVIS-TONKS
Provider First Name:
DOREE
Provider Middle Name:
ERIKA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOVIS
Provider Other First Name:
DOREE
Provider Other Middle Name:
ERIKA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821218264
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5146 NORTH TURRET WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOISE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-610-2061
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1627 SOUTH ORCHARD
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-610-2061
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  LMSW-31016 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 44CF . This is a "MEDI-CAL PRV NBR" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 27BW8 . This is a "MEDI-CAL PRV NBR" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: D8360099 . This is a "DRIVER'S LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com