Provider Demographics
NPI:1013044502
Name:KOSUB, JANE S (LPC,LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:S
Last Name:KOSUB
Suffix:
Gender:F
Credentials:LPC,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 460
Mailing Address - Street 2:105 SOUTH MAIN
Mailing Address - City:ELDORADO
Mailing Address - State:TX
Mailing Address - Zip Code:76936-0460
Mailing Address - Country:US
Mailing Address - Phone:325-853-3669
Mailing Address - Fax:325-853-2922
Practice Address - Street 1:105 SOUTH MAIN
Practice Address - Street 2:
Practice Address - City:ELDORADO
Practice Address - State:TX
Practice Address - Zip Code:76936-0460
Practice Address - Country:US
Practice Address - Phone:325-853-3669
Practice Address - Fax:325-853-2922
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6533101YP2500X
TX1456106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist