Provider Demographics
NPI:1912177338
Name:KOTOSKE, DAVID MICHAEL (MHT, HT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:KOTOSKE
Suffix:
Gender:M
Credentials:MHT, HT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 1/2 E MAIN ST
Mailing Address - Street 2:SUITE #208
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2377
Mailing Address - Country:US
Mailing Address - Phone:574-229-6101
Mailing Address - Fax:
Practice Address - Street 1:227 1/2 E MAIN ST
Practice Address - Street 2:SUITE #208
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2377
Practice Address - Country:US
Practice Address - Phone:574-229-6101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHT 506-271101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional