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General NPI Number Information
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NPI Number | 1720138480
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Entity Type | Individual
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Provider Name | PAUL ARTHUR KOLAK M.A., L.P.C.
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Gender | Male
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 03/12/2009
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Provider Practice Location Address
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Address Line | 1055 CARRIAGE HILL DR
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City | TRAVERSE CITY
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State | MI
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Zip | 49686-5161
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Country | US
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Telephone | 231-995-0870
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Fax |
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Provider Business Mailing Address
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Address Line | 20353 HUNTER RIDGE
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City | LAKE ANN
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State | MI
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Zip | 49650
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Country | US
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Telephone |
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401007685
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License Number State | MI
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