Healthcare Provider Details

I. General information

NPI: 1720194020
Provider Name (Legal Business Name): DAVID P. KOWALSKI LPC, BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 02/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 RICHMOND RD
EDMOND OK
73034-3217
US

IV. Provider business mailing address

1323 RICHMOND RD
EDMOND OK
73034-3217
US

V. Phone/Fax

Practice location:
  • Phone: 405-330-8739
  • Fax:
Mailing address:
  • Phone: 405-330-8739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number943
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: