MEDICARE: ZACHARY J KOWALSKI LCDC, LMSW

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	17584	TX
2	1041C0700X	Clinical Social Worker	116918	TX

General Provider Information

NPI Number	:	1700748597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY J KOWALSKI LCDC, LMSW

Provider Business Mailing Address
First Line	:	PO BOX 2603
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76113-2603
Country	:	US
Telephone Number	:	817-569-4300
Fax Number	:

Provider Business Practice Location Address
First Line	:	3840 HULEN ST
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76107-7277
Country	:	US
Telephone Number	:	817-335-3022
Fax Number	:

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

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/01/2025

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