Provider Demographics
NPI:1730723909
Name:BITKOWSKI, MIRELA
Entity type:Individual
Prefix:
First Name:MIRELA
Middle Name:
Last Name:BITKOWSKI
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 1:109 SHORTHORN ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7770
Mailing Address - Country:US
Mailing Address - Phone:760-793-5312
Mailing Address - Fax:
Practice Address - Street 1:1406 CAMP CRAFT RD STE 205
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-6583
Practice Address - Country:US
Practice Address - Phone:512-862-7426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78871101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional