Provider Demographics
NPI:1164862439
Name:KOZLOWSKI, PATRICK HILARY (LPC)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:HILARY
Last Name:KOZLOWSKI
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2198 US 31 S
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-9618
Mailing Address - Country:US
Mailing Address - Phone:877-398-2013
Mailing Address - Fax:231-723-1735
Practice Address - Street 1:2198 US 31 S
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-9618
Practice Address - Country:US
Practice Address - Phone:877-398-2013
Practice Address - Fax:231-723-1735
Is Sole Proprietor?:No
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010200101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6401010200OtherSTATE OF MICHIGAN LICENSE