Provider Demographics
NPI:1316379167
Name:KOSLAN, KRYSTLE ANN
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:ANN
Last Name:KOSLAN
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 1:83 E SHAW AVE STE 102
Mailing Address - Street 2:101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-7616
Mailing Address - Country:US
Mailing Address - Phone:559-226-0167
Mailing Address - Fax:599-226-1559
Practice Address - Street 1:6051 N FRESNO ST STE 201
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5280
Practice Address - Country:US
Practice Address - Phone:559-248-8550
Practice Address - Fax:559-248-8555
Is Sole Proprietor?:No
Enumeration Date:2013-08-04
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor