Doctor Name: | MARY TSOUKALAS |
NPI Number: | 1043381841 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPCC |
License Number: | E3831 |
Business Practice Address: | 750 E Washington St Suite D-2 Medina, OH - 442562196 |
Business Phone Number: | 3307255333 |
Business Fax Number: | 3307255314 |
Mailing Address: | 750 E Washington St, Suite D-2 MEDINA |
State: | OH |
Postal Code: | 442562196 |
Phone Number: | 3307255333 |
Fax Number: | 3307255314 |
NPI Enumeration Date: | 11/13/2006 |
NPI Last Update Date: | 02/03/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | E3831 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |