Provider Demographics
NPI:1770003543
Name:PRIEST, COSETTA MARLENE (LPC)
Entity Type:Individual
Prefix:
First Name:COSETTA
Middle Name:MARLENE
Last Name:PRIEST
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 1:800 CENTER STREET
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805
Mailing Address - Country:US
Mailing Address - Phone:740-618-0020
Mailing Address - Fax:
Practice Address - Street 1:502 CLAREMONT AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805
Practice Address - Country:US
Practice Address - Phone:419-289-1876
Practice Address - Fax:419-281-6430
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1500542101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1750648424OtherAOD
OH1518986777Medicaid