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NPI Code Detail

MEDICARE: MR. TYLER JAMES ZIELASKO MA, LMHC

MEDICARE: MR. TYLER JAMES ZIELASKO MA, LMHC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1669526653
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TYLER JAMES ZIELASKO MA, LMHC
Provider Business Mailing Address
First Line : 205 14TH ST
Second Line :
City : WINONA LAKE
State : IN
Zip : 46590-1503
Country : US
Telephone Number : 407-920-5398
Fax Number :
Provider Business Practice Location Address
First Line : 3894 NEW VISION DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1708
Country : US
Telephone Number : 260-373-0880
Fax Number : 260-373-0881
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2007
Last Update Date : 06/30/2016

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