Healthcare Provider Details

I. General information

NPI: 1194077628
Provider Name (Legal Business Name): JOSEPH KOWALOW PHD, MA, LMFTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 10/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 E 151ST ST APT 4
CARMEL IN
46033-7777
US

IV. Provider business mailing address

2215 E 151ST ST APT 4
CARMEL IN
46033-7777
US

V. Phone/Fax

Practice location:
  • Phone: 858-213-3935
  • Fax:
Mailing address:
  • Phone: 858-213-3935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number85000103A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: