Provider Demographics
NPI:1336808682
Name:KOOSER, EMILY ANN (LPC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:KOOSER
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 1:4575 32ND AVE S STE 3
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-3305
Mailing Address - Country:US
Mailing Address - Phone:701-353-7579
Mailing Address - Fax:
Practice Address - Street 1:4575 32ND AVE S STE 3
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-3305
Practice Address - Country:US
Practice Address - Phone:701-353-7579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1085-9-15-20101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional