MEDICARE: DANIELLA KOZAN MA

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	221700000X	Art Therapist	18335	TX
2	101YP2500X	Professional Counselor	83268	TX

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	:	1891210100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLA KOZAN MA

Provider Business Mailing Address
First Line	:	12835 MEEHAN DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78727-4518
Country	:	US
Telephone Number	:	646-701-3514
Fax Number	:

Provider Business Practice Location Address
First Line	:	12835 MEEHAN DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78727-4518
Country	:	US
Telephone Number	:	646-701-3514
Fax Number	:

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

Provider Enumeration Date	:	08/08/2017
Last Update Date	:	12/05/2023

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