| Doctor Name: | MS. DEBRA A. TKAC |
| NPI Number: | 1275742751 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PROFESSIONAL CLINICA |
| License Number: | E0002746 |
| Business Practice Address: | 5475 Liberty Ave. Lakeshore Educational & Counseling Services Vermilion, OH - 44089 |
| Business Phone Number: | 4409630402 |
| Business Fax Number: | 4409634018 |
| Mailing Address: | 12315 Reindeer Ave, GARFIELD HEIGHTS |
| State: | OH |
| Postal Code: | 44125 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 05/22/2007 |
| NPI Last Update Date: | 08/05/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | E0002746 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |