MEDICARE: THOMAS WEST KOWALSKI MA LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	3729	CO
2	101YS0200X	School Counselor	0412491	CO

General Provider Information

NPI Number	:	1619286549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS WEST KOWALSKI MA LPC

Provider Business Mailing Address
First Line	:	2756 PLEASANT VALLEY RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-4083
Country	:	US
Telephone Number	:	970-391-1034
Fax Number	:

Provider Business Practice Location Address
First Line	:	2756 PLEASANT VALLEY RD
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80521-4083
Country	:	US
Telephone Number	:	970-391-1034
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2010
Last Update Date	:	09/27/2010

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