| Doctor Name: | JONATHAN TLUSTY |
| NPI Number: | 1013346485 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.A. |
| License Number: | 178008495 |
| Business Practice Address: | 9239 Gross Point Rd Suite 300 Skokie, IL - 600771389 |
| Business Phone Number: | 8476764447 |
| Business Fax Number: | 8476764450 |
| Mailing Address: | 9239 Gross Point Rd, Suite 300 SKOKIE |
| State: | IL |
| Postal Code: | 600771389 |
| Phone Number: | 8476764447 |
| Fax Number: | 8476764450 |
| NPI Enumeration Date: | 11/06/2013 |
| NPI Last Update Date: | 11/06/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 178008495 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |