Basic Information
| Provider Information | |||||||||
| NPI: | 1689097230 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KOWALSKI COUNSELING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15736 RIVER SIDE DR | ||||||||
| Address2: | |||||||||
| City: | SPRING LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494569244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6166389890 | ||||||||
| FaxNumber: | 6168443006 | ||||||||
| Practice Location | |||||||||
| Address1: | 15736 RIVER SIDE DR | ||||||||
| Address2: | |||||||||
| City: | SPRING LAKE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494569244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6166389890 | ||||||||
| FaxNumber: | 6168443006 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2014 | ||||||||
| LastUpdateDate: | 05/08/2014 | ||||||||
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| AuthorizedOfficialLastName: | KOWALSKI | ||||||||
| AuthorizedOfficialFirstName: | MARYANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2316839890 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801065264 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.