MEDICARE: LAURA KOTLOWSKI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	10984	TX
2	101YP2500X	Professional Counselor	71527	TX

General Provider Information

NPI Number	:	1043725401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA KOTLOWSKI

Provider Business Mailing Address
First Line	:	21726 CLIFF VW
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78259-2042
Country	:	US
Telephone Number	:	219-614-4645
Fax Number	:

Provider Business Practice Location Address
First Line	:	641 N WALNUT AVE
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78130-7925
Country	:	US
Telephone Number	:	830-730-6090
Fax Number	:	830-455-4355

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2017
Last Update Date	:	12/07/2017

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Directions to “ LAURA KOTLOWSKI ” Practice Location

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