Michele Koselke, PSYD, HSPP

Primary specialty

PsychologistTaxonomy code 103T00000X

License

20042414A Issued in IN

Practice address

205 N College Ave Ste 312
Bloomington, IN 47404-3953

Phone

(317) 941-3258

Fax

(317) 534-3677

NPI assigned

Apr 8, 2010

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1270684800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599609600000",
    "number": "1013233584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1781 SPRING BEAUTY DR",
            "city": "AVON",
            "state": "IN",
            "postal_code": "461238441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N COLLEGE AVE STE 312",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474043953",
            "telephone_number": "317-941-3258",
            "fax_number": "317-534-3677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOSELKE",
        "first_name": "MICHELE",
        "credential": "PSYD, HSPP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-04-08",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20042414A",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IN",
            "license": "20042414A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelby Koontz
• Logan Koos
• Ava Korinke
• Olivia Korte, RBT
• Andrew Kosak
• Abhinav S Kotaru, RBT
• Anisha Durga Kothari, PA-C
• Georgia Faye Koushiafes, MSW LCSW
• Susan K. Kovacich, O.D.
• Taylor Koziol, RBT

• Psychologist in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.