Healthcare Provider Details

I. General information

NPI: 1881699593
Provider Name (Legal Business Name): TONYA TREZELLE COSEY MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TONYA TREZELLE COSEY MSW, LCSW

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 04/26/2022
Certification Date: 04/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 E STATE ST
CASSOPOLIS MI
49031-9339
US

IV. Provider business mailing address

313 ORCHARD ST
DOWAGIAC MI
49047-1253
US

V. Phone/Fax

Practice location:
  • Phone: 269-445-2451
  • Fax: 269-445-3216
Mailing address:
  • Phone: 269-782-2640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1041C0700X
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: