McKenna N Cosottile, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY61150885 Issued in WA

Practice address

4744 41St Ave SW Ste 101
Seattle, WA 98116-4566

Phone

(206) 320-5780

Fax

(206) 320-5794

NPI assigned

May 14, 2017

Last updated

Jul 13, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• McKenna Corlis Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Integrated Behavioral Health Psychological Services, PLLC

  dba IBH Psychological Services

  • Clinical Psychologist
  • Kalamazoo, MI
  • NPI 1295073393
  NPD (past)

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

{
    "created_epoch": "1494720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626134400000",
    "number": "1326575960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 25608",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841250608",
            "telephone_number": "206-320-4476",
            "fax_number": "206-568-7043"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4744 41ST AVE SW STE 101",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981164566",
            "telephone_number": "206-320-5780",
            "fax_number": "206-320-5794"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COSOTTILE",
        "first_name": "MCKENNA",
        "middle_name": "N",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-14",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WA",
            "license": "PY61150885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MCKENNA",
            "last_name": "CORLIS",
            "credential": "MA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Todd Coryell, PHD
• Ellen Mary Cosgrove, MD
• Tracey Cosgrove, PT
• Kristina Moser Cosley, PT
• Sophia Cosmich
• Beth A. Costa, OT
• Matias Luis Costa Sr., MD
• James Costakis
• Paul Costanza, PH.D.
• Regeena Nicole Costanzo, LSWAIC

• Clinical Psychologist in Seattle, WA
• Providers in Seattle, WA by specialty
• Clinical Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2021; 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.