Healthcare Provider Details

I. General information

NPI: 1629723242
Provider Name (Legal Business Name): KEITH KOWNSLAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2022
Last Update Date: 02/14/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6609 ROBBIE CREEK CV
AUSTIN TX
78750-8139
US

IV. Provider business mailing address

6609 ROBBIE CREEK CV
AUSTIN TX
78750-8139
US

V. Phone/Fax

Practice location:
  • Phone: 512-790-8722
  • Fax:
Mailing address:
  • Phone: 512-790-8722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number87466
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: