Healthcare Provider Details

I. General information

NPI: 1841330024
Provider Name (Legal Business Name): MARY KOWNACKI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2910 KEMP BLVD SUITE 206
WICHITA FALLS TX
76308-1070
US

IV. Provider business mailing address

5 VERA CT
WICHITA FALLS TX
76310-3303
US

V. Phone/Fax

Practice location:
  • Phone: 940-687-1919
  • Fax: 940-696-0837
Mailing address:
  • Phone: 940-733-8746
  • Fax: 940-696-6493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number15383
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: