MEDICARE: BRENNA KOSS LPC, NCC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	178.020600	IL

General Provider Information

NPI Number	:	1437978046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENNA KOSS LPC, NCC

Provider Business Mailing Address
First Line	:	2049 W DIVISION ST APT 2F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-7769
Country	:	US
Telephone Number	:	815-302-3590
Fax Number	:

Provider Business Practice Location Address
First Line	:	2049 W DIVISION ST APT 2F
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-7769
Country	:	US
Telephone Number	:	815-302-3590
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/09/2024
Last Update Date	:	10/09/2024

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