Provider Demographics
NPI:1265975791
Name:KOWAL, TERRELL
Entity type:Individual
Prefix:MS
First Name:TERRELL
Middle Name:
Last Name:KOWAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2677 TRAILWOOD LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-8841
Mailing Address - Country:US
Mailing Address - Phone:859-225-1424
Mailing Address - Fax:
Practice Address - Street 1:2677 TRAILWOOD LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40511-8841
Practice Address - Country:US
Practice Address - Phone:859-225-1424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY104100000X104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker