Basic Information
| Provider Information | |||||||||
| NPI: | 1952711368 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COUSIN | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1722 | ||||||||
| Address2: | |||||||||
| City: | CUMBERLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 215011722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017772285 | ||||||||
| FaxNumber: | 3017775832 | ||||||||
| Practice Location | |||||||||
| Address1: | 10102 COUNTRY CLUB RD SE | ||||||||
| Address2: | |||||||||
| City: | CUMBERLAND | ||||||||
| State: | MD | ||||||||
| PostalCode: | 215028339 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017772285 | ||||||||
| FaxNumber: | 3017775832 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2014 | ||||||||
| LastUpdateDate: | 05/07/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LC5026 | MD | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | LC5026 | MD | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.