MEDICARE: MR. TRENTON KOWALCZUK LPC

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	101YP2500X	Professional Counselor	89782	TX

General Provider Information

NPI Number	:	1518682822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TRENTON KOWALCZUK LPC

Provider Business Mailing Address
First Line	:	7731 MENCHACA RD APT 1207
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-6067
Country	:	US
Telephone Number	:	832-643-8678
Fax Number	:

Provider Business Practice Location Address
First Line	:	7731 MENCHACA RD APT 1207
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-6067
Country	:	US
Telephone Number	:	832-643-8678
Fax Number	:

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

Provider Enumeration Date	:	10/10/2022
Last Update Date	:	02/17/2025

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