Provider Demographics
NPI:1679384614
Name:COSLEY, MICHELLE
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:COSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21429 OAK WAY
Mailing Address - Street 2:
Mailing Address - City:BRIER
Mailing Address - State:WA
Mailing Address - Zip Code:98036-7900
Mailing Address - Country:US
Mailing Address - Phone:530-561-0696
Mailing Address - Fax:
Practice Address - Street 1:21429 OAK WAY
Practice Address - Street 2:
Practice Address - City:BRIER
Practice Address - State:WA
Practice Address - Zip Code:98036-7900
Practice Address - Country:US
Practice Address - Phone:530-561-0696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-17
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty