Provider Demographics
NPI:1710594668
Name:COSPEWICZ, TODD ALBERT (LCPC, CRC)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:ALBERT
Last Name:COSPEWICZ
Suffix:
Gender:M
Credentials:LCPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 AUGUSTA LN
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-4174
Mailing Address - Country:US
Mailing Address - Phone:775-294-1731
Mailing Address - Fax:
Practice Address - Street 1:760 AUGUSTA LN
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-4174
Practice Address - Country:US
Practice Address - Phone:775-294-1731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-24
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP1246-R101YM0800X
00115411225C00000X
CALPCC724101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor