Provider Demographics
NPI:1922505767
Name:COZAD, AMY NICOLE (LPC INTERN)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:NICOLE
Last Name:COZAD
Suffix:
Gender:F
Credentials:LPC INTERN
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:NICOLE
Other - Last Name:COZAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AMY COZAD LPC INTERN
Mailing Address - Street 1:4400 SALEM DALLAS HWY NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-3338
Mailing Address - Country:US
Mailing Address - Phone:971-600-8453
Mailing Address - Fax:
Practice Address - Street 1:4400 SALEM DALLAS HWY NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-3338
Practice Address - Country:US
Practice Address - Phone:971-600-8453
Practice Address - Fax:503-390-3161
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175T00000X
ORR6921101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor