Provider Demographics
NPI:1235345679
Name:KOSEWICK, RISE JACQUELINE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:RISE
Middle Name:JACQUELINE
Last Name:KOSEWICK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22672 ORELLANA
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-1612
Mailing Address - Country:US
Mailing Address - Phone:949-581-7871
Mailing Address - Fax:949-581-7871
Practice Address - Street 1:26451 CROWN VALLEY PKWY
Practice Address - Street 2:#201
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6362
Practice Address - Country:US
Practice Address - Phone:949-581-7871
Practice Address - Fax:949-581-7871
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28530106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist