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General NPI Number Information
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NPI Number | 1568865285
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Entity Type | Individual
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Provider Name | CASEY ROSE KOZLOV M.A., LMFT
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Gender | Female
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Dates
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Enumeration Date | 10/08/2014
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Last Update Date | 11/15/2019
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Provider Practice Location Address
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Address Line | 15811 AMBAUM BLVD SW STE 110
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City | BURIEN
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State | WA
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Zip | 98166-3071
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Country | US
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Telephone | 610-739-9475
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Fax |
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Provider Business Mailing Address
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Address Line | 15811 AMBAUM BLVD SW STE 110
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City | BURIEN
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State | WA
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Zip | 98166-3071
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Country | US
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Telephone | 610-739-9475
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MG 60501427
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MG 60501427
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | CO 60502517
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LF60721682
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License Number State | WA
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