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General NPI Number Information
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NPI Number | 1508241134
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Entity Type | Organization
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Legal Business Name | KOSIA-IG-LLC
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Dates
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Enumeration Date | 07/24/2015
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Last Update Date | 07/24/2015
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Provider Practice Location Address
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Address Line | 1044 CASTELLO DR STE 210
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City | NAPLES
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State | FL
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Zip | 34103-1900
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Country | US
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Telephone | 239-248-4708
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Fax |
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Provider Business Mailing Address
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Address Line | 1044 CASTELLO DR STE 210
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City | NAPLES
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State | FL
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Zip | 34103-1900
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Country | US
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Telephone | 230-248-4708
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | OLESYA KARAKOSTA
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Credential | PHD
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Telephone | 239-248-4708
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH11443
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License Number State | FL
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