MEDICARE: LISA KOSS

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	101YP2500X	Professional Counselor	E.2303942	OH
2	101YM0800X	Mental Health Counselor	MH19399	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619547494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA KOSS

Provider Business Mailing Address
First Line	:	1390 BRYSON RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-2013
Country	:	US
Telephone Number	:	954-471-6075
Fax Number	:

Provider Business Practice Location Address
First Line	:	1390 BRYSON RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43224-2013
Country	:	US
Telephone Number	:	954-471-6075
Fax Number	:

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

Provider Enumeration Date	:	06/25/2021
Last Update Date	:	03/25/2025

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Directions to “ LISA KOSS ” Practice Location

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