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General NPI Number Information
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NPI Number | 1376840843
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Entity Type | Individual
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Provider Name | PATRICIA KOZLOWSKI PTAK M.A. LPC
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Gender | Female
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Dates
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Enumeration Date | 02/18/2011
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Last Update Date | 02/18/2011
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Provider Practice Location Address
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Address Line | 670 GRISWOLD ST SUITE 3
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City | NORTHVILLE
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State | MI
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Zip | 48167-2675
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Country | US
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Telephone | 248-347-3470
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Fax |
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Provider Business Mailing Address
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Address Line | 46160 LITCHFIELD DR
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City | PLYMOUTH
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State | MI
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Zip | 48170-3543
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Country | US
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Telephone | 734-416-8526
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6401005949
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License Number State | MI
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