Provider Demographics
NPI:1164618195
Name:KOSTER, STEVEN JAY (COUNSELRO EDUC LTD)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:JAY
Last Name:KOSTER
Suffix:
Gender:M
Credentials:COUNSELRO EDUC LTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:801 HAZEN STREET SUITE C
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-0249
Mailing Address - Country:US
Mailing Address - Phone:269-657-5574
Mailing Address - Fax:269-657-3474
Practice Address - Street 1:57150 CR 681
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:MI
Practice Address - Zip Code:49057
Practice Address - Country:US
Practice Address - Phone:269-621-2800
Practice Address - Fax:269-621-2962
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008703101Y00000X
MI6301012982103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor