Provider Demographics
NPI:1619017944
Name:KOSSE, RAYMOND (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:KOSSE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1512 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-2123
Mailing Address - Country:US
Mailing Address - Phone:208-263-2533
Mailing Address - Fax:208-255-2017
Practice Address - Street 1:212 N 1ST AVE STE G101
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1400
Practice Address - Country:US
Practice Address - Phone:208-263-7180
Practice Address - Fax:208-255-2017
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW-260841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical