MEDICARE: AMY NICOLE COZAD LPC

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	C10744	OR
2	101Y00000X	Counselor	R6921	OR

General Provider Information

NPI Number	:	1922505767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY NICOLE COZAD LPC

Provider Business Mailing Address
First Line	:	821 SAGINAW ST S
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4121
Country	:	US
Telephone Number	:	971-600-8453
Fax Number	:

Provider Business Practice Location Address
First Line	:	821 SAGINAW ST S
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97302-4121
Country	:	US
Telephone Number	:	971-600-8453
Fax Number	:

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

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	03/04/2026

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Directions to “ AMY NICOLE COZAD LPC” Practice Location

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