Provider Demographics
NPI:1780950956
Name:JENNIFER J. KOZEL, PHD, LCP, INC.
Entity type:Organization
Organization Name:JENNIFER J. KOZEL, PHD, LCP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOZEL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:605-348-6500
Mailing Address - Street 1:1818 W FULTON ST
Mailing Address - Street 2:STE. 201
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-4377
Mailing Address - Country:US
Mailing Address - Phone:605-348-6500
Mailing Address - Fax:605-341-7409
Practice Address - Street 1:1818 W FULTON ST
Practice Address - Street 2:STE. 201
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-4377
Practice Address - Country:US
Practice Address - Phone:605-348-6500
Practice Address - Fax:605-341-7409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-31
Last Update Date:2012-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD432103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS8194Medicare PIN