Doctor Name: | JOHN CUSULOS |
NPI Number: | 1053558445 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.A., LP.C., LAT |
License Number: | LAT-154 |
Business Practice Address: | 1430 Wilkins Circle Casper, WY - 82601 |
Business Phone Number: | 3072379583 |
Business Fax Number: | 3072657277 |
Mailing Address: | 1430 Wilkins Circle, CASPER |
State: | WY |
Postal Code: | 82601 |
Phone Number: | 3072379583 |
Fax Number: | 3072657277 |
NPI Enumeration Date: | 01/07/2009 |
NPI Last Update Date: | 01/07/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | LAT-154 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |