Provider Demographics
NPI:1225526429
Name:KOZFKAY, ASHLEY ANNE
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ANNE
Last Name:KOZFKAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 44TH ST SW STE E
Mailing Address - Street 2:
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-3363
Mailing Address - Country:US
Mailing Address - Phone:616-856-7113
Mailing Address - Fax:616-719-2677
Practice Address - Street 1:185 44TH ST SW STE E
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-3363
Practice Address - Country:US
Practice Address - Phone:616-856-7113
Practice Address - Fax:616-719-2677
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-24
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013523101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health