Healthcare Provider Details

I. General information

NPI: 1134053036
Provider Name (Legal Business Name): MIKENNA ANNE KOSSOW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 SHERIDAN BLVD STE 315C
ARVADA CO
80003-6160
US

IV. Provider business mailing address

31510 HILLTOP RD
GOLDEN CO
80403-7313
US

V. Phone/Fax

Practice location:
  • Phone: 720-523-3189
  • Fax:
Mailing address:
  • Phone: 916-752-8515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC.0023948
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: