Provider Demographics
NPI:1437551728
Name:KOSAK, LAURA (LMFT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:KOSAK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10035 WAGNER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-7805
Mailing Address - Country:US
Mailing Address - Phone:415-605-3638
Mailing Address - Fax:
Practice Address - Street 1:10035 WAGNER CREEK RD
Practice Address - Street 2:
Practice Address - City:TALENT
Practice Address - State:OR
Practice Address - Zip Code:97540-7805
Practice Address - Country:US
Practice Address - Phone:415-605-3638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-18
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR4800101YM0800X
ORT1673106H00000X
ORT2903106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health