Provider Demographics
NPI:1518524958
Name:KOWAL, MARSHALL ALEXANDER (LPC, NCC, NREMT)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:ALEXANDER
Last Name:KOWAL
Suffix:
Gender:M
Credentials:LPC, NCC, NREMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 HORIZON DR STE 225
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8743
Mailing Address - Country:US
Mailing Address - Phone:970-668-3478
Mailing Address - Fax:
Practice Address - Street 1:360 PEAK ONE DRIVE
Practice Address - Street 2:STE.110
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-668-9054
Practice Address - Fax:970-668-0632
Is Sole Proprietor?:No
Enumeration Date:2019-05-21
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0013205101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional