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General NPI Number Information
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NPI Number | 1174016406
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Entity Type | Individual
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Provider Name | MICHAEL KOWALSKI LPC-INTERN
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Gender | Male
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Dates
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Enumeration Date | 06/12/2018
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Last Update Date | 06/12/2018
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Provider Practice Location Address
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Address Line | 804 PECAN GROVE RD E
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City | SHERMAN
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State | TX
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Zip | 75090-1767
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Country | US
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Telephone | 903-893-7768
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Fax | 903-893-4979
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Provider Business Mailing Address
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Address Line | 509 BULLINGHAM LN
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City | ALLEN
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State | TX
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Zip | 75002-4458
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Country | US
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Telephone | 972-849-4665
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 75124
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License Number State | TX
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