Individual
KEVIN R KOSIK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CADC-R ,QMHA-R, CHW
Contact information
Practice address
555 SE MARTIN LUTHER KING JR BLVD STE 3057, PORTLAND, OR 97214-2120
(503) 470-9844
(503) 715-4175
Mailing address
3374 SE HOLGATE BLVD, PORTLAND, OR 97202-3459
(503) 470-9844
(503) 447-2076
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
T-24-3714
OR
101YM0800X
Mental Health Counselor
QMHA-R-5143
OR
101YM0800X
Mental Health Counselor
—
—
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
04/01/2024
Last updated
11/19/2025
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