Provider Demographics
NPI:1366859837
Name:AWDYKOWYZ, MARK (LPC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:AWDYKOWYZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 DAVID DUVAL CT
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-5814
Mailing Address - Country:US
Mailing Address - Phone:402-450-3207
Mailing Address - Fax:
Practice Address - Street 1:3313 KESTREL LORE CT
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-0001
Practice Address - Country:US
Practice Address - Phone:737-216-4391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-1815101YP2500X
IL178.006500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional