Provider Demographics
NPI:1952181448
Name:KOSTMAN, SKI MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:SKI
Middle Name:MARIE
Last Name:KOSTMAN
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 1:1500 14TH ST W STE 290
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:ND
Mailing Address - Zip Code:58801-4078
Mailing Address - Country:US
Mailing Address - Phone:701-751-0299
Mailing Address - Fax:
Practice Address - Street 1:1500 14TH ST W STE 290
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-4078
Practice Address - Country:US
Practice Address - Phone:701-751-0299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1084-9-15-20101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional