Provider Demographics
NPI:1912396516
Name:KOSHAR, PETER JOHN JR (LMSW)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JOHN
Last Name:KOSHAR
Suffix:JR
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57418 COUNTY ROAD 681 STE B
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49057-9422
Mailing Address - Country:US
Mailing Address - Phone:269-657-5574
Mailing Address - Fax:269-445-3836
Practice Address - Street 1:57418 COUNTY ROAD 681
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:MI
Practice Address - Zip Code:49057-9421
Practice Address - Country:US
Practice Address - Phone:269-657-5574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health