Provider Demographics
NPI:1558660977
Name:COSSEL, SHELLI (LPC)
Entity Type:Individual
Prefix:
First Name:SHELLI
Middle Name:
Last Name:COSSEL
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 1:185 W MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2744
Mailing Address - Country:US
Mailing Address - Phone:678-640-8608
Mailing Address - Fax:
Practice Address - Street 1:185 W MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2744
Practice Address - Country:US
Practice Address - Phone:678-640-8608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-24
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004869101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional