Provider Demographics
NPI:1427381094
Name:KOSOBUTSKY, KSENIA (LMFTA)
Entity Type:Individual
Prefix:
First Name:KSENIA
Middle Name:
Last Name:KOSOBUTSKY
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 116TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3045
Mailing Address - Country:US
Mailing Address - Phone:720-432-1244
Mailing Address - Fax:
Practice Address - Street 1:20660 NE 79TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-7517
Practice Address - Country:US
Practice Address - Phone:720-432-1244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG 60225340106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist