Provider Demographics
NPI:1841330024
Name:KOWNACKI, MARY (LPC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:KOWNACKI
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 1:5 VERA CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-3303
Mailing Address - Country:US
Mailing Address - Phone:940-733-8746
Mailing Address - Fax:940-696-6493
Practice Address - Street 1:2910 KEMP BLVD
Practice Address - Street 2:SUITE 206
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-1070
Practice Address - Country:US
Practice Address - Phone:940-687-1919
Practice Address - Fax:940-696-0837
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15383101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX028827601Medicaid