Provider Demographics
NPI:1851952915
Name:LAKOWSKY, MARY THERESA (LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:THERESA
Last Name:LAKOWSKY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6804 SANTA MARIA LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-2846
Mailing Address - Country:US
Mailing Address - Phone:214-458-7763
Mailing Address - Fax:
Practice Address - Street 1:1545 W MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5014
Practice Address - Country:US
Practice Address - Phone:214-821-9554
Practice Address - Fax:214-821-9080
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74759101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor