Provider Demographics
NPI:1306468293
Name:KOZAR, HEATHER M (LMSW)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:KOZAR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2221 1 1/2 MILE RD
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:MI
Mailing Address - Zip Code:49052-9632
Mailing Address - Country:US
Mailing Address - Phone:269-261-5961
Mailing Address - Fax:
Practice Address - Street 1:2221 1 1/2 MILE RD
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:MI
Practice Address - Zip Code:49052-9632
Practice Address - Country:US
Practice Address - Phone:269-261-5961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-13
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011059771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical