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NPI Code Detail

MEDICARE: JESSICA KOSS MA, LLC

MEDICARE: JESSICA KOSS MA, LLC
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
1101YM0800XMental Health Counselor6451022937MI

General Provider Information

NPI Number : 1851074983
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA KOSS MA, LLC
Provider Business Mailing Address
First Line : 23580 ORCHARD LAKE RD
Second Line :
City : FARMINGTON HILLS
State : MI
Zip : 48336-3241
Country : US
Telephone Number : 734-724-2061
Fax Number :
Provider Business Practice Location Address
First Line : 23580 ORCHARD LAKE RD
Second Line :
City : FARMINGTON HILLS
State : MI
Zip : 48336-3241
Country : US
Telephone Number : 734-724-2061
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2023
Last Update Date : 08/07/2023

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Directions to “ JESSICA KOSS MA, LLC” Practice Location

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