Provider Demographics
NPI:1194077628
Name:KOWALOW, JOSEPH (PHD, MA, LMFTA)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:KOWALOW
Suffix:
Gender:M
Credentials:PHD, MA, LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 E 151ST ST APT 4
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-7777
Mailing Address - Country:US
Mailing Address - Phone:858-213-3935
Mailing Address - Fax:
Practice Address - Street 1:2215 E 151ST ST APT 4
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-7777
Practice Address - Country:US
Practice Address - Phone:858-213-3935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN85000103A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist