Provider Demographics
NPI:1174980601
Name:KOSOVEC, MARCIA MARGARET (LPC)
Entity type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:MARGARET
Last Name:KOSOVEC
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 1:1525 N EAST MULLETT LAKE RD
Mailing Address - Street 2:
Mailing Address - City:INDIAN RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49749-9158
Mailing Address - Country:US
Mailing Address - Phone:248-561-3611
Mailing Address - Fax:
Practice Address - Street 1:1525 N EAST MULLETT LAKE RD
Practice Address - Street 2:
Practice Address - City:INDIAN RIVER
Practice Address - State:MI
Practice Address - Zip Code:49749-9158
Practice Address - Country:US
Practice Address - Phone:248-561-3611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401004972101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health