Healthcare Provider Details

I. General information

NPI: 1205382272
Provider Name (Legal Business Name): MICHAEL M KOCET PH.D. LMHC, ACS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2016
Last Update Date: 08/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3656 N HALSTED ST
CHICAGO IL
60613-5974
US

IV. Provider business mailing address

325 N WELLS ST
CHICAGO IL
60654-7024
US

V. Phone/Fax

Practice location:
  • Phone: 312-467-2158
  • Fax:
Mailing address:
  • Phone: 312-467-2158
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5664
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: