Provider Demographics
NPI:1245836311
Name:KOZAK, TIMOTHY PAUL (MED, LPC)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:PAUL
Last Name:KOZAK
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 W MARKET ST
Mailing Address - Street 2:
Mailing Address - City:PERKASIE
Mailing Address - State:PA
Mailing Address - Zip Code:18944-1480
Mailing Address - Country:US
Mailing Address - Phone:267-240-8971
Mailing Address - Fax:
Practice Address - Street 1:528 W MARKET ST
Practice Address - Street 2:
Practice Address - City:PERKASIE
Practice Address - State:PA
Practice Address - Zip Code:18944-1480
Practice Address - Country:US
Practice Address - Phone:267-240-8971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC011980101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional