Provider Demographics
NPI:1144906207
Name:KOSTICH-CONNORS, JULIE (LLPC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:KOSTICH-CONNORS
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:KOSTICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:20 PINE RUN
Mailing Address - Street 2:
Mailing Address - City:NEGAUNEE
Mailing Address - State:MI
Mailing Address - Zip Code:49866-9673
Mailing Address - Country:US
Mailing Address - Phone:775-385-8445
Mailing Address - Fax:
Practice Address - Street 1:20 PINE RUN
Practice Address - Street 2:
Practice Address - City:NEGAUNEE
Practice Address - State:MI
Practice Address - Zip Code:49866-9673
Practice Address - Country:US
Practice Address - Phone:775-385-8445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6451022425101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional