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General NPI Number Information
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NPI Number | 1265948863
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Entity Type | Organization
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Legal Business Name | DEL SOUL COUNSELING PLLC
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Dates
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Enumeration Date | 12/18/2017
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Last Update Date | 12/18/2017
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Provider Practice Location Address
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Address Line | 15396 N 83RD AVE STE G103
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City | PEORIA
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State | AZ
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Zip | 85381-5629
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Country | US
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Telephone | 602-785-2449
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Fax | 602-785-2449
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Provider Business Mailing Address
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Address Line | PO BOX 5231
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City | PEORIA
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State | AZ
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Zip | 85385-5231
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Country | US
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Telephone | 602-785-2449
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. COLLEEN MAY KOWALKE
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Credential | PSYD
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Telephone | 623-261-8770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 4545
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License Number State | AZ
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