MEDICARE: CATHERINE LUCILE KOZAK CESNIK MFT

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	106H00000X	Marriage & Family Therapist	2086	TN

General Provider Information

NPI Number	:	1467176644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE LUCILE KOZAK CESNIK MFT

Provider Business Mailing Address
First Line	:	5003 DAKOTA AVE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-3533
Country	:	US
Telephone Number	:	504-338-2811
Fax Number	:

Provider Business Practice Location Address
First Line	:	4900 CENTENNIAL BLVD STE 300
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-1105
Country	:	US
Telephone Number	:	615-852-5761
Fax Number	:

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

Provider Enumeration Date	:	09/30/2022
Last Update Date	:	09/30/2022

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