Organization
CHOICES FOR CHANGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALICE LEONORA KOSS MASTERS PSYCHOLOGIST (THERAPIST)
(269) 344-7997
Entity
Organization
Contact information
Practice address
218 W WALNUT ST, KALAMAZOO, MI 49007-5131
(269) 344-7997
Mailing address
6418 CYPRESS STREEET, PORTAGE, MI 49002
(269) 327-3144
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
6301008528
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6301008528
LIMITED LICENSED PSYCHOLO
MI
Enumeration date
05/03/2007
Last updated
07/30/2008
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