MEDICARE: MRS. ANGELA MARIE KOSMAS MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor		MI
2	101YP2500X	Professional Counselor
3	101YM0800X	Mental Health Counselor	L1331297	MI

General Provider Information

NPI Number	:	1962720805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANGELA MARIE KOSMAS MA, LPC

Provider Business Mailing Address
First Line	:	42815 GARFIELD RD STE 201
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-1143
Country	:	US
Telephone Number	:	586-212-1569
Fax Number	:	586-948-9304

Provider Business Practice Location Address
First Line	:	42815 GARFIELD RD STE 201
Second Line	:
City	:	CLINTON TOWNSHIP
State	:	MI
Zip	:	48038-1143
Country	:	US
Telephone Number	:	586-212-1569
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2010
Last Update Date	:	06/22/2021

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