Healthcare Provider Details

I. General information

NPI: 1700748597
Provider Name (Legal Business Name): ZACHARY J KOWALSKI LCDC, LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 HULEN ST
FT WORTH TX
76107-7277
US

IV. Provider business mailing address

PO BOX 2603
FT WORTH TX
76113-2603
US

V. Phone/Fax

Practice location:
  • Phone: 817-335-3022
  • Fax:
Mailing address:
  • Phone: 817-569-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number17584
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number116918
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: