Provider Demographics
NPI:1558946210
Name:COSSETTE, EMBERLENE (LISCW)
Entity Type:Individual
Prefix:
First Name:EMBERLENE
Middle Name:
Last Name:COSSETTE
Suffix:
Gender:F
Credentials:LISCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 9TH AVE SW APT 5-204
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5179
Mailing Address - Country:US
Mailing Address - Phone:253-230-9362
Mailing Address - Fax:
Practice Address - Street 1:2323 9TH AVE SW APT 5-204
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5179
Practice Address - Country:US
Practice Address - Phone:253-230-9362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-15
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WALW6131684101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health