Healthcare Provider Details

I. General information

NPI: 1518524958
Provider Name (Legal Business Name): MARSHALL ALEXANDER KOWAL LPC, NCC, NREMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2019
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 PEAK ONE DRIVE STE.110
FRISCO CO
80443
US

IV. Provider business mailing address

715 HORIZON DR STE 225
GRAND JUNCTION CO
81506-8743
US

V. Phone/Fax

Practice location:
  • Phone: 970-668-9054
  • Fax: 970-668-0632
Mailing address:
  • Phone: 970-668-3478
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0013205
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: