Provider Demographics
NPI:1225794605
Name:KOSOSKI, KATHRYN (LPC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:KOSOSKI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 SHORELINE DR STE 151
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-0176
Mailing Address - Country:US
Mailing Address - Phone:940-222-2399
Mailing Address - Fax:
Practice Address - Street 1:1100 E SOUTHLAKE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6381
Practice Address - Country:US
Practice Address - Phone:817-756-1293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80184101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80184OtherLPC LICENSE