Healthcare Provider Details

I. General information

NPI: 1174016406
Provider Name (Legal Business Name): MICHAEL KOWALSKI LPC-INTERN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2018
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 PECAN GROVE RD E
SHERMAN TX
75090-1767
US

IV. Provider business mailing address

509 BULLINGHAM LN
ALLEN TX
75002-4458
US

V. Phone/Fax

Practice location:
  • Phone: 903-893-7768
  • Fax: 903-893-4979
Mailing address:
  • Phone: 972-849-4665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number75124
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: