Provider Demographics
NPI:1144361478
Name:KATOVSICH, ANDREW THOMAS (MA, LLP)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:THOMAS
Last Name:KATOVSICH
Suffix:
Gender:M
Credentials:MA, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 679
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-0679
Mailing Address - Country:US
Mailing Address - Phone:269-985-2000
Mailing Address - Fax:269-985-2002
Practice Address - Street 1:903 MAIN ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-1426
Practice Address - Country:US
Practice Address - Phone:269-985-2000
Practice Address - Fax:269-985-2002
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010974103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling